Foster A H, Gold M R, McLaughlin J S
Department of Surgery, University of Maryland School of Medicine, Baltimore 21201.
Ann Thorac Surg. 1995 Feb;59(2):294-300. doi: 10.1016/0003-4975(94)00878-b.
Standard postoperative dual-chamber pacing uses ventricular leads placed on the right ventricle that produce dysynchronous ventricular activation and contraction. The hypothesis that simultaneous stimulation of both ventricles by atrio-biventricular pacing improves hemodynamic performance compared with that observed with standard atrio-monoventricular pacing was tested in 18 patients 12 to 36 hours after elective coronary artery revascularization. Temporary epicardial pacing electrodes were placed on the right atrium and into anterior paraseptal sites on the right and left ventricle. Simultaneous biventricular activation was documented by fusion morphology of surface electrocardiograms and by isochronal epicardial activation mapping during biventricular pacing. Hemodynamic data were acquired after 10 minutes of pacing at a fixed overdrive rate during atrial pacing and during dual-chamber pacing using unipolar right ventricular, unipolar left ventricular, and bipolar biventricular (left ventricular cathode) leads. Atrio-biventricular pacing increased cardiac index and decreased systemic vascular resistance compared with atrial pacing and with atrio-right ventricular and atrio-left ventricular dual-chamber pacing (p < 0.05). These data support the use of atrio-biventricular pacing employing paraseptal electrodes to optimize hemodynamic performance.
标准的术后双腔起搏使用置于右心室的心室导线，会产生不同步的心室激活和收缩。在18例择期冠状动脉血运重建术后12至36小时的患者中，对房室双心室起搏同时刺激两个心室相比标准房室单心室起搏能改善血流动力学表现这一假说进行了检验。将临时心外膜起搏电极置于右心房以及右心室和左心室的前间隔旁部位。通过体表心电图的融合形态以及双心室起搏期间的等时心外膜激活标测记录双心室同步激活。在以固定超速频率起搏10分钟后，使用单极右心室、单极左心室和双极双心室（左心室阴极）导线，在心房起搏和双腔起搏期间采集血流动力学数据。与心房起搏以及房室右心室和房室左心室双腔起搏相比，房室双心室起搏增加了心脏指数并降低了全身血管阻力（p < 0.05）。这些数据支持使用采用间隔旁电极的房室双心室起搏来优化血流动力学表现。
