Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany.
Martin-Luther-University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle/Saale, Germany.
Med Klin Intensivmed Notfmed. 2022 Apr;117(3):227-234. doi: 10.1007/s00063-021-00806-3. Epub 2021 Mar 31.
Transcoronary pacing is a seldom used treatment option for unheralded bradycardias in the setting of percutaneous coronary interventions (PCI). In the present study we compared a coated guidewire inserted proximally into a coronary artery with a cutaneous patch electrode as indifferent electrodes for transcoronary pacing in a porcine model.
Transcoronary pacing was investigated in 7 adult pigs in an animal catheterization laboratory. A standard guidewire insulated by a monorail-balloon was advanced into the periphery of a coronary artery serving as the cathode. As the indifferent anode, a special guidewire with electrical insulated by a polytetrafluoroethylene (PTFE) coating was positioned into the proximal part of the same coronary vessel. Transcoronary pacing parameters (threshold and impedance data and the magnitude of the epicardial electrogram) were compared with unipolar transcoronary pacing using a cutaneous patch electrode.
Transcoronary pacing was successful against both indifferent electrodes. Pacing thresholds obtained with the coated guidewire technique (1.8 ± 1.3 V) were similar to those obtained by standard unipolar transcoronary pacing with a cutaneous patch electrode (1.8 ± 1.5 V). The impedance with the additional coated guidewire was 419 ± 144 Ω and thereby slightly higher compared to 320 ± 103 Ω obtained by pacing against the patch electrode (p < 0.05). Both settings yielded comparable R‑wave amplitudes (8.0 ± 5.1 mV vs. 7.1 ± 3.6 mV).
A second coated guidewire is as effective as a cutaneous patch electrode when added as an indifferent electrode in transcoronary pacing. This transcoronary pacing technique could replace temporary transvenous pacing in emergency situations during PCI, especially when using the radial approach.
经皮冠状动脉介入治疗（PCI）时，冠状窦起搏是一种很少使用的治疗未预料到的心动过缓的方法。在本研究中，我们比较了将一根涂覆的导丝近端插入冠状动脉作为阴极，与使用皮肤贴片电极作为经冠状窦起搏的无关电极在猪模型中的效果。
在动物导管实验室中对 7 头成年猪进行了经冠状窦起搏研究。一根带有单轨球囊绝缘的标准导丝被推进到作为阴极的冠状动脉的外围。作为无关阳极，一根带有聚四氟乙烯（PTFE）涂层的电绝缘特殊导丝被定位到同一冠状动脉的近端部分。将经冠状窦起搏参数（阈值和阻抗数据以及心外膜电图的幅度）与使用皮肤贴片电极的单极经冠状窦起搏进行比较。
使用两种无关电极均成功进行了经冠状窦起搏。使用涂覆导丝技术获得的起搏阈值（1.8±1.3 V）与使用皮肤贴片电极进行标准单极经冠状窦起搏获得的阈值（1.8±1.5 V）相似。附加涂覆导丝的阻抗为 419±144 Ω，略高于与贴片电极起搏时获得的 320±103 Ω（p<0.05）。两种设置均产生可比的 R 波幅度（8.0±5.1 mV 与 7.1±3.6 mV）。
当作为经冠状窦起搏的无关电极添加时，第二根涂覆的导丝与皮肤贴片电极一样有效。这种经冠状窦起搏技术可以在 PCI 期间的紧急情况下替代临时经静脉起搏，尤其是在使用桡动脉入路时。
