Tada Shizuka, Shibata Masayoshi, Ohno Seiko, Haruki Yasunobu, Murakami Hironori, Hotta Daisuke, Nojima Masanori, Ruhnke Gregory W
Department of Clinical Laboratory Medicine Hokkaido Cardiovascular Hospital Sapporo Japan.
Department of Cardiology Hokkaido Cardiovascular Hospital Sapporo Japan.
J Arrhythm. 2018 Mar 23;34(3):261-266. doi: 10.1002/joa3.12037. eCollection 2018 Jun.
The optimal implantation site of a new implantable cardiac monitor (ICM) named Reveal LINQ may be limited based on a sufficient amplitude of R wave potential (AEP) acquisition because it is the same anatomic area used for transthoracic echocardiography (TTE).
Among 18 healthy volunteers, we assessed AEPs in 3 combinations through parasternal placement of 2 electrodes, (i) in the 4th intercostal space (ICS; site A/setting a; A/a), (ii) the same setting in the 5th ICS (site B/setting a; B/a), and (iii) in a sagittal plane relative to the left sternal border at the 4th ICS (site A/setting b; A/b), and further measured AFPs in several body positions in all site-setting combinations: supine, left and right lateral decubitus, sitting, and standing. The degree of interference with TTE performance was assessed by placement of an imitation ICM in setting a at both sites A and B.
Only the AEPs in A/a and B/a met the criteria (AEP ≥ 0.3 mV) in all positions. The AEPs in the supine position with all combinations were higher than those achieved in other positions ( < .001). The imitation interfered with TTE performance at site A among 78% of subjects, but only 17% at site B ( = .0006). The end-diastolic dimension of the left ventricle at site A was decreased after the imitation placement ( = .028). At site B, all female subjects complained of discomfort because their brassieres overlaid the imitation.
The B/a combination is optimal; however, the personal discomfort related to brassieres should be considered.
名为Reveal LINQ的新型植入式心脏监测器（ICM）的最佳植入部位可能因R波电位（AEP）采集的足够幅度而受到限制，因为它与经胸超声心动图（TTE）使用的解剖区域相同。
在18名健康志愿者中，我们通过在胸骨旁放置2个电极以3种组合评估AEP，（i）在第4肋间间隙（ICS；部位A/设置a；A/a），（ii）在第5肋间间隙的相同设置（部位B/设置a；B/a），以及（iii）在第4肋间间隙相对于左胸骨边缘的矢状面（部位A/设置b；A/b），并在所有部位 - 设置组合的多个身体位置进一步测量房颤电位（AFP）：仰卧位、左侧和右侧卧位、坐位和站立位。通过在部位A和B的设置a处放置模拟ICM来评估对TTE性能的干扰程度。
仅A/a和B/a中的AEP在所有位置均符合标准（AEP≥0.3 mV）。所有组合在仰卧位时的AEP均高于其他位置时的AEP（P <.001）。在78%的受试者中，模拟物在部位A干扰了TTE性能，但在部位B仅为17%（P =.0006）。在部位A放置模拟物后，左心室舒张末期内径减小（P =.028）。在部位B，所有女性受试者均抱怨不适，因为她们的胸罩覆盖了模拟物。
B/a组合是最佳的；然而，应考虑与胸罩相关的个人不适。
