Goldman B S, Chisholm A W, MacGregor D C, Froggatt G M
Can J Surg. 1978 Mar;21(2):138-40.
Atrial pacing has electrophysiologic and hemodynamic advantages for patients with symptomatic bradyarrhythmias and intact atrioventricular conduction or with certain refractory tachyarrhythmias. Permanent atrial pacing has been achieved in 29 patients followed up for periods of up to 7 years at two institutions. At Sunnybrook Medical Centre, Toronto, 16 patients have had coronary sinus electrodes introduced pervenously using standard bipolar or special unipolar catheters. Initial pacing thresholds were acceptably low (mean, 2.0 mA); chronic thresholds in three patients were similar. At the Toronto General Hospital, 13 patients had endocardial J-electrodes, bipolar or tined unipolar, inserted in the right atrial appendage. Initial thresholds were low (mean, 1.3 mA) and P-wave voltage was adequate (3.4 mV) for pacemakers with standard sensitivity. In both series, conventional R-inhibited, asynchronous or rate-programmable units have been employed. Radiofrequency self-conversion pacemakers were used in three patients. Preliminary His bundle studies were done in 10 patients; the others were tested by rapid atrial pacing during insertion of electrodes. Early and late electrode stability in both series was excellent; one electrode became dislodged from the coronary sinus position and one from the right atrial appendage.
对于有症状的缓慢性心律失常且房室传导正常或患有某些难治性快速性心律失常的患者，心房起搏具有电生理和血流动力学优势。在两家机构对29例患者进行了长达7年的随访，实现了永久性心房起搏。在多伦多的桑尼布鲁克医疗中心，16例患者通过使用标准双极或特殊单极导管经静脉插入冠状窦电极。初始起搏阈值低至可接受水平（平均2.0 mA）；3例患者的慢性阈值与此相似。在多伦多总医院，13例患者在右心耳插入了心内膜J形电极，双极或带倒刺单极。初始阈值较低（平均1.3 mA），对于具有标准灵敏度的起搏器，P波电压足够（3.4 mV）。在这两个系列中，均采用了传统的R抑制型、非同步型或频率程控型起搏器。3例患者使用了射频自转换起搏器。对10例患者进行了初步的希氏束研究；其他患者在电极插入过程中通过快速心房起搏进行测试。两个系列中电极的早期和晚期稳定性都很好；1根电极从冠状窦位置脱位，1根从右心耳脱位。
