Gessman L J, Gallagher J D, MacMillan R M, Morse D, Clark D L, Maranhao V
Pacing Clin Electrophysiol. 1984 Sep;7(5):917-21. doi: 10.1111/j.1540-8159.1984.tb05633.x.
We developed a new electrode to convert rapidly a previously inserted pulmonary artery or left ventricular catheter into a pacemaker. One method of doing this is by withdrawal of the pulmonary artery catheter from the pulmonary artery to the right ventricle by pressure control, and a Teflon-coated guide wire, stripped of 5 mm of insulation at its tip, is advanced through the catheter to contact the endocardium. In the second method, the pacing electrode is advanced through the distal lumen of the catheter while it is positioned within the pulmonary artery and withdrawn into the right ventricle while pacing. Finally, a third method involves advancement of the guide wire electrode into the left ventricle through a pigtail catheter. To pace, the guide wire electrode is connected to the cathode of a pacemaker referenced to a skin electrode. We paced 10 of 10 right heart cardiac catheterization, intra- and postoperative surgery patients by methods 1 and 2, and 4 of 4 left heart catheterization patients by method 3. Thresholds (mean +/- SEM) for guide wire pacing were: right ventricle 1.52 +/- 0.4 mA; left ventricle 1.33 +/- 0.1 mA. Guide wire pacing is rapid, reliable, and requires little operator skill. Our indications for guide wire pacing are: 1) emergency right ventricular pacing in operative or intensive care unit patients with unexpected bradyarrhythmias who have an indwelling pulmonary artery catheter; and 2) emergency left ventricular pacing in left heart cardiac catheterization patients with contrast-induced bradyarrhythmias.
我们研发了一种新型电极，可迅速将先前插入的肺动脉导管或左心室导管转换为起搏器。一种实现方法是通过压力控制将肺动脉导管从肺动脉撤回至右心室，然后将一根在尖端剥去5毫米绝缘层的涂有特氟龙的导丝穿过导管，使其接触心内膜。第二种方法是，在导管位于肺动脉内时，将起搏电极通过导管的远端腔推进，然后在起搏的同时将其撤回至右心室。最后，第三种方法是将导丝电极通过猪尾导管推进到左心室。为进行起搏，将导丝电极连接到以皮肤电极为参考的起搏器阴极。我们通过方法1和2对10例右心心脏导管插入术患者（术中及术后）进行了起搏，通过方法3对4例左心导管插入术患者进行了起搏。导丝起搏的阈值（平均值±标准误）为：右心室1.52±0.4毫安；左心室1.33±0.1毫安。导丝起搏快速、可靠，且所需的操作技能很少。我们进行导丝起搏的适应证为：1）在手术室或重症监护病房中，有肺动脉导管留置且意外发生缓慢性心律失常的患者进行紧急右心室起搏；2）在左心导管插入术患者中，因造影剂诱发缓慢性心律失常而进行紧急左心室起搏。
