Shah Bakhtawar, Amir Niaz Muhammad, Saidullah Shahab, Zaman Farrukh, Mumtaz Hassan, Ghazanfar Aamir
Division of Clinical Cardiac Electrophysiology, Department of Cardiology, Hayatabad Medical Complex, Peshawar, PAK.
Interventional Cardiology, Ali Medical Center, Islamabad, PAK.
Cureus. 2021 Apr 12;13(4):e14436. doi: 10.7759/cureus.14436.
Permanent pacemakers' (PPM) implantation is an integral part of electrophysiology and general cardiology. The implantation technique has evolved a lot since the first implantation. Several innovations have been undertaken to improve the effectiveness, life of the transplant, and patient outcomes. In this study, we introduced a new implantation technique to improve the procedure and possibly reduce the rate of complication.
This study was conducted from January 2016 to February 2017 in Hayatabad Medical Complex, Peshawar. Patients destined for implantation of PPM based on a clinical treatment plan, after proper explanation of the procedure, were brought to the catheterization laboratory. Venogram of the upper limb performed. Patients were scrubbed and draped. The axillary vein was approached via the Seldinger technique. About 2 to 3 cm superolateral to the puncture site, a skin incision was made and subcutaneous pocket constructed, and a guidewire external end was pulled in from inside the pocket keeping the venous end at the place. Subsequently, in a routine way, lead was placed, secured and the wound was closed in layers.
A total of 690 PPM were implanted under the study. About 290 devices were implanted in the conventional way and 380 devices via the trans-axillary approach. The mean implantation time was less than 30 minutes via the trans-axillary approach. Immediate and delayed complications of the procedure were minimal.
Trans-axillary approach holds some significant advantages over the conventional technique. The subcutaneous pocket and venous puncture successfully reduce the burden of foreign material, minimize the tension on the wound, shorten implantation time and reduce the chances of erosion of the device.
永久性起搏器（PPM）植入是电生理学和普通心脏病学的一个重要组成部分。自首次植入以来，植入技术已经有了很大的发展。为了提高有效性、移植寿命和患者预后，人们进行了多项创新。在本研究中，我们引入了一种新的植入技术来改进手术过程，并可能降低并发症发生率。
本研究于2016年1月至2017年2月在白沙瓦的哈亚塔巴德医疗中心进行。根据临床治疗计划注定要植入PPM的患者，在对手术过程进行适当解释后，被带到导管室。进行上肢静脉造影。患者进行皮肤消毒和铺巾。通过Seldinger技术进入腋静脉。在穿刺部位上方约2至3厘米处做一个皮肤切口，构建皮下囊袋，并将导丝外端从囊袋内拉出，同时将静脉端留在原处。随后，按常规方式放置导线、固定并分层缝合伤口。
在该研究中总共植入了690个PPM。约290个装置采用传统方式植入，380个装置通过经腋路植入。经腋路植入的平均时间少于30分钟。该手术的即刻和延迟并发症极少。
经腋路相对于传统技术具有一些显著优势。皮下囊袋和静脉穿刺成功减轻了异物负担，使伤口张力最小化，缩短了植入时间，并减少了装置侵蚀的机会。
