Spencer W H, Zhu D W, Markowitz T, Badruddin S M, Zoghbi W A
Baylor College of Medicine, Houston Texas, USA.
Pacing Clin Electrophysiol. 1997 Nov;20(11):2739-45. doi: 10.1111/j.1540-8159.1997.tb05431.x.
By pacing both atria simultaneously, one could reliably predict and optimize left-sided AV timing without concern for IACT. With synchronous depolarization of the atria, reentrant arrhythmias might be suppressed. We studied four male patients (73 +/- 3 years) with paroxysmal atrial fibrillation and symptomatic bradyarrhythmias using TEE and fluoroscopy as guides; a standard active fixation screw-in lead (Medtronic model #4058) was attached to the interatrial septum and a standard tined lead was placed in the ventricle. The generators were Medtronic model 7960. The baseline ECG was compared to the paced ECG and the conduction time were measured to the high right atrium, distal coronary sinus and atrial septum in normal sinus rhythm, atrial septal pacing, and AAT pacing. On the surface ECG, no acceleration or delay in AV conduction was noted during AAI pacing from the interatrial septum as compared with normal sinus rhythm. The mean interatrial conduction time for all 4 patients was 106 +/- 2 ms; the interatrial conduction time measured during AAT pacing utilizing the atrial septal pacing lead was 97 +/- 4 ms (P = NS). During atrial septal pacing, the mean conduction time to the high right atrium was 53 +/- 2 ms. The mean conduction time to the lateral left atrium during atrial septal pacing, was likewise 53 +/- 2 ms. We conclude that it is possible to pace both atria simultaneously from a single site using a standard active fixation lead guided by TEE and fluoroscopy. Such a pacing system allows accurate timing of the left-sided AV delay.
通过同时对双心房进行起搏，可以可靠地预测和优化左侧房室传导时间，而无需考虑心房内传导时间（IACT）。随着心房的同步去极化，折返性心律失常可能会被抑制。我们使用经食管超声心动图（TEE）和荧光透视作为引导，研究了4例患有阵发性心房颤动和症状性缓慢性心律失常的男性患者（73±3岁）；将一根标准的主动固定螺旋电极导线（美敦力型号#4058）连接到房间隔，将一根标准的有翼电极导线置于心室。起搏器为美敦力7960型号。将基线心电图与起搏心电图进行比较，并在正常窦性心律、房间隔起搏和心房同步起搏（AAT）时测量到高位右心房、冠状窦远端和房间隔的传导时间。在体表心电图上，与正常窦性心律相比，从房间隔进行AAI起搏时未发现房室传导加速或延迟。4例患者的平均房间传导时间为106±2毫秒；利用房间隔起搏导线在AAT起搏期间测量的房间传导时间为97±4毫秒（P=无显著性差异）。在房间隔起搏期间，到高位右心房的平均传导时间为53±2毫秒。在房间隔起搏期间，到左侧左心房外侧的平均传导时间同样为53±2毫秒。我们得出结论，在TEE和荧光透视引导下，使用标准的主动固定导线可以从单个部位同时对双心房进行起搏。这样的起搏系统能够准确设定左侧房室延迟时间。
