Gheyath Bashaer, Khatiwala Roshni Vijay, Chen Shaomin, Fu Zhifan, Beri Neil, English Carter, Bang Heejung, Srivatsa Uma, Pezeshkian Nayereh, Atsina Kwame, Fan Dali
Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California.
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
Heart Rhythm O2. 2022 Oct 18;4(1):18-23. doi: 10.1016/j.hroo.2022.10.005. eCollection 2023 Jan.
Fluoroscopy is the standard tool for transvenous implantation of traditional and leadless pacemakers (LPs). LPs are used to avoid complications of conventional pacemakers, but there still is a 6.5% risk of major complications. Mid-right ventricular (RV) septal device implantation is suggested to decrease the risk, but helpful cardiac landmarks cannot be visualized under fluoroscopy. Transesophageal echocardiography (TEE) is an alternative intraprocedural imaging method.
The purpose of this study was to explore the spatial relationship of the LP to cardiac landmarks via TEE and their correlations with electrocardiographic (ECG) parameters, and to outline an intraprocedural method to confirm mid-RV nonapical lead positioning.
Fifty-six patients undergoing implantation of LP with TEE guidance were enrolled in the study. Device position was evaluated by fluoroscopy, ECG, and TEE. Distances between the device and cardiac landmarks were measured by TEE and analyzed with ECG parameters with and without RV pacing.
Mid-RV septal positioning was achieved in all patients. TEE transgastric view (0°-40°/90°-130°) was the optimal view for visualizing device position. Mean tricuspid valve-LP distance was 4.9 ± 0.9 cm, mean pulmonary valve-LP distance was 4.2 ± 1 cm, and calculated RV apex-LP distance was 2.9 ± 1 cm. Mean LP paced QRS width was 160.8 ± 28 ms and increased from 117.2 ± 34 ms at baseline. LP RV pacing resulted in left bundle branch block pattern on ECG and 37.8% QRS widening by 43.5 ± 29 ms.
TEE may guide LP implantation in the nonapical mid-RV position. Further studies are required to establish whether this technique reduces implant complications compared with conventional fluoroscopy.
荧光透视检查是经静脉植入传统起搏器和无导线起搏器（LP）的标准工具。LP用于避免传统起搏器的并发症，但仍有6.5%的严重并发症风险。建议在右心室（RV）间隔中部植入装置以降低风险，但在荧光透视检查下无法看到有用的心脏标志。经食管超声心动图（TEE）是一种术中替代成像方法。
本研究的目的是通过TEE探索LP与心脏标志的空间关系及其与心电图（ECG）参数的相关性，并概述一种术中确认RV中部非心尖部导线定位的方法。
本研究纳入了56例在TEE引导下植入LP的患者。通过荧光透视检查、ECG和TEE评估装置位置。通过TEE测量装置与心脏标志之间的距离，并分析有无RV起搏时的ECG参数。
所有患者均实现了RV间隔中部定位。TEE经胃视图（0°-40°/90°-130°）是观察装置位置的最佳视图。三尖瓣-LP平均距离为4.9±0.9cm，肺动脉瓣-LP平均距离为4.2±1cm，计算得出的RV心尖-LP距离为2.9±1cm。LP起搏时QRS平均宽度为160.8±28ms，较基线时的117.2±34ms增加。LP RV起搏导致ECG上出现左束支传导阻滞图形，37.8%的QRS增宽43.5±29ms。
TEE可引导LP在RV非心尖部中部位置植入。需要进一步研究以确定与传统荧光透视检查相比，该技术是否能减少植入并发症。
