Heinroth Konstantin M, Carter Justin M, Buerke Michael, Mahnkopf Dirk, Werdan Karl, Prondzinsky Roland
J Invasive Cardiol. 2009 Dec;21(12):634-8.
Transcoronary pacing for the treatment of bradycardia during percutaneous coronary intervention (PCI) is not well established, but may be a useful technique in interventional cardiology. We developed a porcine model to examine the feasibility and efficacy of transcoronary pacing during PCI.
Eight pigs under general anesthesia underwent unipolar transcoronary pacing with a standard floppy guidewire in a coronary artery (as the cathode) and a skin patch electrode (as the anode). We examined the effect of skin-patch position (groin vs. anterior or posterior chest wall), the presence of an angioplasty balloon on the guidewire and also which coronary artery was "wired" on the efficacy of pacing as assessed by capture and threshold data. Pacing with the bare guidewire and a maximum output of 10 V was successful in 54% of the animals with a groin patch and the anterior chestwall patch, but in 100% with a posterior chest-wall patch. The pacing thresholds were 8.3 +/- 2.2 V, 7.6 +/- 2.8 V and 3.4 +/- 2.4 V with the patch in these sites, respectively. With an angioplasty balloon over the guidewire, pacing efficacy increased to 100% (irrespective of the target vessel or patch location) and pacing thresholds were significantly reduced (p < 0.05) to 2.7 +/- 1.5 (with a groin patch) and 1.0 +/- 0.7 V (with a posterior chestwall patch). With optimal pacing set-up (posterior chest-wall patch and angioplasty-balloon insulation), pacing thresholds were similar to those obtained with standard bipolar transvenous pacing at 1.2 +/- 0.8 V. We did not observe any adverse effects of coronary pacing. Skeletal muscle contraction was only generated at high-output levels.
This pig model examines the practicalities of transcoronary pacing and shows that this technique can produce 100% capture at thresholds comparable to the transvenous approach. This technique may have a role during PCI, particularly in an emergency situation.
经冠状动脉起搏用于在经皮冠状动脉介入治疗（PCI）期间治疗心动过缓的方法尚未完全确立，但可能是介入心脏病学中的一种有用技术。我们建立了一个猪模型来研究PCI期间经冠状动脉起搏的可行性和有效性。
八只接受全身麻醉的猪在冠状动脉中使用标准软头导丝（作为阴极）和皮肤贴片电极（作为阳极）进行单极经冠状动脉起搏。我们通过捕捉和阈值数据评估了皮肤贴片位置（腹股沟与前胸壁或后胸壁）、导丝上血管成形术球囊的存在以及所起搏的冠状动脉对起搏效果的影响。使用裸导丝且最大输出为10V进行起搏时，使用腹股沟贴片和前胸壁贴片的动物中有54%成功起搏，但使用后胸壁贴片时成功率为100%。在这些部位使用贴片时，起搏阈值分别为8.3±2.2V、7.6±2.8V和3.4±2.4V。当导丝上有血管成形术球囊时，起搏成功率提高到100%（无论目标血管或贴片位置如何），起搏阈值显著降低（p<0.05），使用腹股沟贴片时为2.7±1.5V，使用后胸壁贴片时为1.0±0.7V。采用最佳起搏设置（后胸壁贴片和血管成形术球囊绝缘）时，起搏阈值与标准双极经静脉起搏时相似，为1.2±0.8V。我们未观察到冠状动脉起搏的任何不良反应。仅在高输出水平时才会产生骨骼肌收缩。
该猪模型研究了经冠状动脉起搏的实用性，并表明该技术在与经静脉途径相当的阈值下可实现100%的捕捉。该技术在PCI期间可能具有作用，尤其是在紧急情况下。
