Pang Benjamin J, Joshi Subodh B, Lui Elaine H, Tacey Mark A, Alison Jeff, Seneviratne Sujith K, Cameron James D, Mond Harry G
Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia.
Pacing Clin Electrophysiol. 2014 Jun;37(6):717-23. doi: 10.1111/pace.12330. Epub 2013 Dec 20.
There have been rare case reports of damage to adjacent coronary arteries by screw-in pacemaker and implantable cardioverter-defibrillator (ICD) leads. Our aim was to assess the proximity of pacemaker and ICD leads to the major coronary anatomy using cardiac computed tomography (CT).
Cardiac CT images were retrospectively analyzed to assess the spatial relationship of device lead tips to the major coronary anatomy.
Fifty-two right ventricular (RV) leads (17 apical, 35 nonapical) and 35 right atrial (RA) leads were assessed. Leads on the RV antero-septal junction (20 of 52) were close (median 4.7 mm) to, and orientated toward, the left anterior descending (LAD) coronary artery. RA leads in the anterior (26 of 35) and lateral (seven of 35) walls of the RA appendage were not close to (16.9 ± 7.7 mm and 18.9 ± 12.4 mm, respectively) and directed away from the right coronary artery. However, an RA lead adjacent to the superior border of the tricuspid valve was 4.3 mm from the right coronary artery and an RA lead on the medial wall of the RA appendage was 1.6 mm away from the aorta. An RV pacemaker lead in the lateral wall of the RV inlet was 3.4 mm from the right coronary artery.
In our cohort, a majority of RV leads were on the antero-septal junction and close to the overlying LAD coronary artery. RA leads adjacent to the tricuspid valve or on the medial RA appendage were in close proximity to the right coronary artery and aorta, respectively.
有罕见病例报告称，旋入式起搏器和植入式心脏复律除颤器（ICD）导线会损伤相邻冠状动脉。我们的目的是使用心脏计算机断层扫描（CT）评估起搏器和ICD导线与主要冠状动脉解剖结构的接近程度。
对心脏CT图像进行回顾性分析，以评估设备导线尖端与主要冠状动脉解剖结构的空间关系。
评估了52根右心室（RV）导线（17根心尖部导线，35根非心尖部导线）和35根右心房（RA）导线。位于RV前间隔交界处的导线（52根中的20根）靠近左前降支（LAD）冠状动脉（中位数4.7mm）并朝向该动脉。位于RA心耳前壁（35根中的26根）和侧壁（35根中的7根）的RA导线与右冠状动脉不接近（分别为16.9±7.7mm和18.9±12.4mm）且方向远离右冠状动脉。然而，一根靠近三尖瓣上缘的RA导线距离右冠状动脉4.3mm，一根位于RA心耳内侧壁的RA导线距离主动脉1.6mm。一根位于RV入口侧壁的RV起搏器导线距离右冠状动脉3.4mm。
在我们的队列中，大多数RV导线位于前间隔交界处且靠近上方的LAD冠状动脉。靠近三尖瓣或位于RA内侧心耳的RA导线分别与右冠状动脉和主动脉接近。
