Das Asit, Kahali Dhiman, Dutta Shibananda
Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, India.
B. M. Birla Heart Research Centre, Kolkata, India.
Indian Heart J. 2017 Nov-Dec;69(6):725-730. doi: 10.1016/j.ihj.2017.06.003. Epub 2017 Jun 12.
Sinus node disease is associated with widespread structural and electrophysiological changes in the atria in addition to abnormalities at the sinus node. The atrial conduction disorder in patients with atrial pacing results in higher incidence of atrial fibrillation. Studies have shown that low interatrial septal pacing is superior to right atrial appendage pacing in preventing persistent or permanent atrial fibrillation in these patients. However, implantation of active fixation lead in low interatrial septal position is difficult and time consuming with conventional stylet, inhibiting application of this method in routine practice.
The technique of implanting atrial pacing lead in low interatrial septum with hand-made stylet is presented in this study with emphasis on fluoroscopic landmark and electrocardiographic P wave pattern.
The results indicate acute and short-term success of low interatrial septal pacing in 10 patients out of 11 patients without major complications. Pacing parameters during implantation and 3 months post procedure were within normal limits.
The initial favorable results of this study indicate low interatrial septal pacing with conventional active fixation lead using fluoroscopic landmark and electrocardiographic characteristics is feasible and reproducible with a simple technique.
窦房结疾病除了窦房结存在异常外，还与心房广泛的结构和电生理变化有关。心房起搏患者的心房传导障碍会导致心房颤动的发生率更高。研究表明，在预防这些患者发生持续性或永久性心房颤动方面，低位房间隔起搏优于右心耳起搏。然而，使用传统的探条在低位房间隔位置植入主动固定导线困难且耗时，这限制了该方法在常规实践中的应用。
本研究介绍了使用自制探条在低位房间隔植入心房起搏导线的技术，重点强调了透视标志和心电图P波形态。
结果表明，11例患者中有10例低位房间隔起搏获得急性和短期成功，且无 major并发症。植入过程中和术后3个月的起搏参数均在正常范围内。
本研究的初步良好结果表明，利用透视标志和心电图特征，采用传统主动固定导线进行低位房间隔起搏是可行的，且通过一种简单的技术可重复。
