Shettigar U R, Loungani R R, Smith C A
Department of Medicine, Veterans Administration Medical Center, Wilmington, Delaware.
Clin Cardiol. 1989 May;12(5):267-74. doi: 10.1002/clc.4960120508.
The incidence of inadvertent permanent ventricular pacing from the coronary vein is not known. In a retrospective analysis of 69 patients in whom transvenous pacemakers were implanted between 1979 and 1986, 12 patients were discovered to have right bundle-branch block pattern to the paced complexes on electrocardiogram. In this group, three patients were considered to have inadvertent placement of pacing lead in the coronary vein by two-dimensional echocardiographic criteria. No complications were noted in follow-up of 2-79 months. Monitoring of surface electrocardiogram, frontal and lateral fluoroscopy, and pacing threshold and sensing parameters (during implantation of pacemaker) were found to offer no absolute protection against malplacement of the lead. Placement of the lead into the lung field via the main pulmonary artery and then withdrawing with eventual positioning into the right ventricular apex will avoid malposition into the coronary vein. Two-dimensional echocardiography is useful for the diagnosis of pacing lead malplacement and should be performed in any patient with right bundle-branch block pattern in the surface electrocardiogram following pacemaker implantation.
经冠状静脉意外永久性心室起搏的发生率尚不清楚。在一项对1979年至1986年间植入经静脉起搏器的69例患者的回顾性分析中，发现12例患者心电图上的起搏复合波呈右束支传导阻滞图形。在该组中，根据二维超声心动图标准，3例患者被认为起搏导线意外置入冠状静脉。在2至79个月的随访中未发现并发症。发现监测体表心电图、前后位和侧位透视以及起搏阈值和感知参数（在起搏器植入期间）并不能绝对防止导线误置入。将导线经主肺动脉置入肺野，然后回撤并最终定位到右心室尖部可避免误置入冠状静脉。二维超声心动图有助于诊断起搏导线误置入，对于起搏器植入后体表心电图出现右束支传导阻滞图形的任何患者均应进行此项检查。
