经左锁骨下静脉床边紧急心脏临时起搏16例

经静脉紧急安置心脏临时起搏器,是抢救突发严重缓慢性心律失常或伴有阿斯综合征等危重患者的重要措施,但迄今为止,床旁无X线指引时紧急临时心脏起搏仍未获得较为满意的,能被普遍接受的方法。我院采用国产带指引钢丝的电极导管经左锁骨下静脉穿刺作临时床边紧急起搏16例,均获成功,现报告如下。 1 资料和方法 1.1 临床资料 16例中男11例,女5例,年龄36～72(平均65.3)岁。病因:急性心肌梗塞8例,急性心肌炎5例,病窦综合征3例;心律失常类型:Ⅲ度房室传导阻滞10例(其中1例为三束支阻滞伴室性逸搏心律),严重窦性心动过缓伴窦性停搏6例。16例中11例伴有阿斯综合征发作。     

经锁骨下静脉床旁临时心脏起搏60例分析

目的：探讨床旁经锁骨下静脉心脏起搏的应用价值。方法：回顾分析60例采用床旁经锁骨下静脉心脏临时起搏的床旁效果。结果：所有病例均获得良好效果，无严重并发症。结论：应用经锁骨下静脉心脏临时起搏具有操作快捷，成功率高，患者创伤小的特点，值得推广应用。     

经锁骨下静脉床旁临时心脏起搏术：附17例报告

经锁骨下静脉床旁临时心脏起搏术（附１７例报告）哈尔滨医科大学附属第一医院心内科（１５０００１）杨树森，赵侃，孟繁超，王东明，谷宏越哈尔滨市第五医院心内科杨丽华在实施临时心脏起搏抢救缓慢性心律失常时，多数操作者选取股静脉径路，因其操作方法易掌握、并发症...     

经左锁骨下静脉床旁紧急心脏临时起搏的应用

本文收集我科自 1997年 1月～ 2 0 0 0年 1月进行床旁经左锁骨下静脉紧急临时心脏起搏 2 0例 ,现报道如下。1　资料与方法1 1　一般资料　本组病例共 2 0例 ,其中男 12例 ,女 8例。年龄 13～ 78岁。冠心病 15例 ,其中急性下壁心肌梗塞 9例 ,广泛前壁心肌梗塞 2例 ,右室梗塞 1例 ,下壁、后壁、右室梗塞 1例 ,不稳定型心绞痛2例 ;急性病毒性心肌炎 2例 ;急性风湿热1例 ;洋地黄中毒 1例 ;快慢综合征 1例。心律失常类型有Ⅲ度房室传导阻滞 12例 ,窦性心动过缓 4例 ,Ⅱ度Ⅱ型房室传导阻滞 2例 ,窦性停搏、尖端扭转型室性心动过速各 1例 ,并且患者…     

经左锁骨下静脉插入导管床边紧急心脏临时起搏25例

目的：报告经左锁骨下静脉穿刺插入带引导钢丝的电极导管行右心室起搏２５例经验。方法：经左锁骨下静脉插入导管，在心腔内心电图指引下判断电极到达右心室，将脉宽调至０．５ｍｓ测起搏阈值；将电压调至５Ｖ，频率６０～７０次／分恒定起搏。结果：开始穿刺至起搏成功３～８分钟（平均５．９分钟），起搏时间３～１６天。其中９例术后Ｘ线摄片、５例因植入永久心脏起搏器透视证实电极位于右心室心尖部。起搏期间１例伴急性左心衰竭，经调整电极后起搏良好，未再脱位；１例３束支传导阻滞合并室性逸搏心律患者，术后出现精神症状，经予脑细胞活化剂及多虑平３天后恢复正常；全部患者心电图均为完全性左束支阻滞图形，未出现心脏穿孔、血气胸等并发症，经治疗均痊愈出院。结论：本法创伤小，起搏电流低，患者无痛苦，能较长时间保持有效起搏；无需Ｘ线引导，易于推广急救应用     

9号穿刺针引导经锁骨下静脉穿刺紧急临时心脏起搏

1995年 8月～ 2 0 0 0年 8月 ,我们在无床旁 X线透视指引的情况下 ,改进穿刺方法 ,对 2 4例患者进行了紧急床旁临时心脏起搏 ,获得成功 ,报告如下。1　临床资料1.1　病例 :本组 2 4例中男 19例 ,女 5例 ;平均年龄 5 8.2岁 ( 15～ 81岁 )。起搏前为严重心动过缓伴不同程度的阿斯综合征发作 (心室率 <40次 / min) ,或为心跳骤停。经静注阿托品或静滴异丙肾上腺素或心肺复苏效果不佳 ,改为床旁紧急心脏起搏。 Medtronic公司 5 318型体外心脏起搏器 ,5 F或 6 F双极右心临时起搏电极 ,6 F或 7F带止血阀动脉鞘 ,18号薄壁穿刺针 ,J型导引钢丝及 …     

心腔内心电图监测经锁骨下静脉床旁临时心脏起搏术

心腔内心电图监测经锁骨下静脉床旁临时心脏起搏术杨丽华，杨树森，王岚峰，赵进军，孟繁超经股静脉径路实施临时心脏起搏以其方法安全而广泛应用于临床。近年来我们在无Ｘ线监视情况下对１５例患者采用锁骨下静脉径路进行临时心脏起搏，取得良好效果，报告如下。资料和方...     

经左锁骨下静脉床旁盲插普通电生理导管紧急临时心脏起搏抢救心脏骤停

目的探讨经左锁骨下静脉床旁盲插普通电生理导管行紧急临时心脏起搏器的急救与护理配合经验,提高救治成功率。方法回顾分析该院1998年12月至2005年6月115例患者在无X线透视条件下,利用普通电生理导管,经左锁骨下静脉盲插至右心室进行紧急临时起搏的抢救护理经验。结果112例患者左锁骨下静脉穿刺成功,顺利将临时起搏导管送至右心室,3例失败;在起搏期间有1例患者发生电极脱位,重新调整后恢复正常。从开始穿刺至起搏成功时间（420±10．8）8,起搏肯定,无并发症发生。结论心跳骤停等患者行紧急临时心脏起搏器抢救时。术前做好相关急救准备,术中加强配合及监护,术后密切观察病情及预见性的护理。注意并发症的预防及发生是抢救成功的关键。     

经左锁骨下静脉与右股静脉插入导管床旁紧急心脏临时起搏的比较

目的：比较经左锁骨下静脉与右股静脉插入导管床旁紧急心脏临时起搏的优缺点。方法：11例病人经左锁骨下静脉穿刺在心腔内心电图指引下插入起搏电极导管起搏右心室成功。18例经右股静脉穿刺在心腔内心电图指引下插入起搏电极导管起搏右心室成功．3例为经锁骨下静脉放置失败后改由经右股静脉放置获得成功。结果：经左锁骨下静脉穿刺插入起搏电极至起料成功用时4～12分钟(平均8.7分钟）。经右股静脉穿刺插入起搏电机至起搏成功用时3～16分钟(平均8.3分钟)结论：两种穿刺方法都较可靠,但经右股静脉穿刺更为方便,安全．可靠。尤其适应于心脏骤停病人心肺复苏的同时进行心脏临时起搏。     

普通起搏电极经左锁骨下静脉紧急床旁临时心脏起搏

经静脉置入临时心脏起搏器是对严重心动过缓、传导阻滞、心脏停搏等情况所进行的一种安全有效的抢救措施[1,2 ] 。大多在Ｘ线透视下放置临时起搏电极 ,但在患者病情危重、不宜搬动的情况下 ,经床旁盲插临时起搏电极 ,能及时抢救患者生命 ,提高抢救成功率。我院自 1996年 8月至 2 0 0 2年 1月 ,在非Ｘ线、心电图指导下 ,以左锁骨下静脉为穿刺径路 ,使用普通起搏电极 ,共为 32例患者实施了紧急床旁临时心脏起搏 ,取得满意疗效 ,现报道如下。1　资料与方法1.1　临床资料　本组 32例均为我院住院及急诊科患者。其中 ,男 19例 ,女 13例 ,年龄 19…     

Permanent Ventricular Pacing Via the Great Cardiac Vein

Two cases of left ventricular pacing via the great cardiac vein are presented. A 64-year-old female with a mechanical prosthetic tricuspid valve and slow atrial fibrillation had a failed attempt at pacing from the middle cardiac vein. In a 58-year-old male with hypertrophic obstructive cardiomyopathy and brodycardia tachycardia svndrome. transvenous permanent pacing could not be achieved via the right ventricle or middle cardiac vein. In both cases, successful pacing via the great cardiac vein was achieved but with an elevated stimulation threshold. These cases illustrate an alternate transvenous route when difficulties occur using standard ventricular pacing sites.     

Emergency Cardiac Pacing for Severe Bradycardia

ALTAMURA, G., ET AL.: Emergency Cardiac Pacing for Severe Bradycardia. Our study included the treatment of transcutaneous cardiac pacing (TCP) in 32 patients: (A) 19 patients were treated in the emergency area for complete symptomatic AV block before endocavitary pacing; (B) five patients were in asystole following DC shock or out-of-hospital cardiac arrest; and (C) eight patients were affected by bifascicular block undergoing emergency surgery and were treated in order to prevent complete AV block. Two transcutaneous stimulators were used. PaceAid-CRC model 50/52 with 20-msec pulse width; the electrodes were positioned on the V, ECG position and on the back. Results: in all but two patients, it was possible to obtain stable cardiac capture; in one patient arrived in hospital in asystole after prolonged cardiac arrest and in the other one was affected by complete AV block, TCP was ineffective. In groups A and B, TCP was maintained for a mean time of 15 minutes; in group C, TCP was tested in all patients, but performed in only one patient during surgery. Mean threshold was 81 mA. Stimulation was well tolerated in all but five patients. TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by medical staff. In our opinion, it should be considered as the first choice emergency treatment of severe symptomatic bradycardia. In asystole, beneficial effects can be obtained only if TCP is performed early enough after the onset of arrhythmia.     

Ventricular Pacing from the Middle Cardiac Vein Mimicking Supraventricular Morphology

A case is described in which ventricular pacing from the middle cardiac vein produced an electrocardiographic pattern which mimicked the morphology of the normally conducted beats. The possible etiologies of this unusual phenomenon and its implications concerning the functional anatomy of the normal conduction system in the human heart are discussed.     

Electrophysiological and Clinical Comparison of Two Temporary Pacing Leads Following Cardiac Surgery

Temporary pacing leads are invaluable in diagnosis and treatment of arrhythmia after cardiac surgery. The ideal lead possesses reliable pacing and sensing capabilities throughout the postoperative period. Ease of handling and a low complication rate are essential. This study compares a new lead (Medtronic model #6492) to a temporary pacemaker lead established in clinical use (Medtronic model #6500). One lead of each type was placed in the right atrium and ventricle in 33 patients undergoing elective coronary revascularization. Pacing function was measured on the first and fourth postoperative days. Lead complications were documented. On day 1, there was no statistical difference between lead types in terms of pacing (voltage threshold, current threshold), impedance, or sensing (P wave amplitude, R wave amplitude). On day 4, both leads showed an increase in pacing threshold and a decrease in sensing ability. The only statistical difference between lead types was in atrial sensing on day 4, as measured by the P wave amplitudes (1.95 +/- 0.18 V for model 6492 vs 1.40 +/- 0.14 V for model 6500, P < 0.05). Two leads of each model failed to pace in the ventricular position and one lead in each model in the atrial position. There were no complications attributable to either pacemaker lead. We found that both lead types were reliable and functioned well. The Medtronic Model #6492 lead demonstrated better long-term sensing, although in this study the difference was not clinically significant.     

Transcutaneous Cardiac Pacing: Evaluation of Cardiac Activation

ALTAMURA, G., ET AL.: Transcutaneous Cardiac Pacing: Evaluation of Cardiac Activation. The effects of transcutaneous cardiac pacing (TCP) on cardiac activation were evaluated by endocavitary recording (HRA, RVA) in eight patients, in order to test the possibility to obtain a simultaneous atrial and ventricular stimulation. The transcutaneous pacemaker used was the Pace Aid 52 (pacing rate 50–160 ppm, current output 10–150 mA, pulse width 20 sec). The two skin electrodes [surface area 50 cm²) were placed on the chest in anteroposterior position. Ventricular capture was observed in all patients [threshold = 74 ± 14 mA), simultaneous atrial capture was obtained in only four cases (threshold = 138 ± 25 mA). In conclusion, our data show that four-chamber simultaneous stimulation by TCP is possible, but only with pacing energies much higher than those usually required to capture the ventricle. The ability of TCP to simultaneously pace the atria and ventricles, though not relevant in the emergency cardiac stimulation for symptomatic severe bradyarrhythmias, could be useful in the treatment of reentrant supraventricular tachycardias.     

Alternative Techniques for Left Ventricular Pacing in Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) is an important treatment modality for a well‐defined subgroup of heart failure patients. Coronary sinus (CS) lead placement is the first‐line clinical approach but the insertion is unsuccessful in about 5–10% of the patients. In recent years, the number of CRT recipients and the considerable need for left ventricular (LV) lead revisions increased enormously. Numerous techniques and technologies have been specifically developed to provide alternatives for the CS LV pacing. Currently, the surgical access is most frequently used as a second choice by either minithoracotomy or especially the video‐assisted thoracoscopy. The transseptal or transapical endocardial LV lead implantations are being developed but there are no longer follow‐up data in larger patient cohorts. These new techniques should be reserved for patients failing conventional or surgical CRT implants. In the future, randomized studies are needed to asses the potential benefits of some alternative LV pacing techniques and other new technologies for LV lead placement are expected.     

气管内紧急心脏起搏抢救心跳骤停的临床应用

目的:探讨紧急床边气管内心脏起搏在心肺复苏中的成功率。方法:对50例心跳骤停患者紧急行改良气管导管插管,插管成功后即行气管内心脏起搏。结果:50例中41例有起搏信号,起搏成功率为82%,28例临床有效,临床有效率为56%,其中21例复苏成功,复苏成功率为42%。结论:紧急床边气管内心脏起搏设备、操作简单,不影响胸外按压和进行其它急救措施,是抢救心跳骤停的一种有效措施。     

Mapping the Coronary Sinus and Great Cardiac Vein

GIUDICI, M., et al. : Mapping the Coronary Sinus and Great Cardiac Vein. The purpose of this study was to develop a better understanding of the pacing and sensing characteristics of electrodes placed in the proximal cardiac veins. A detailed mapping of the coronary sinus (CS) and great cardiac vein (GCV) was done on 25 patients with normal sinus rhythm using a deflectable electrophysiological catheter. Intrinsic bipolar electrograms and atrial and ventricular pacing voltage thresholds were measured. For measurement purposes, the GCV and the CS were each subdivided into distal (D), middle (M), and proximal (P) regions, for a total of six test locations. Within the CS and GCV, the average atrial pacing threshold was always lower (  P < 0.05  ) than the ventricle with an average ventricular to atrial ratio > 5, except for the GCV-D. The average atrial threshold in the CS and GCV ranged from 0.2– to 1.0-V higher than in the atrial appendage. Diaphragmatic pacing was observed in three patients. Atrial signal amplitude was greatest in the CS-M, CS-D, and GCV-P and smaller in the CS-P, GCV-M, and GCV-D. Electrode spacing did not significantly affect P wave amplitude, while narrower electrode spacing attenuated R wave amplitude. The average P:R ratio was highest with 5-mm-spaced electrodes compared to wider spaced pairs. The P:R ratio in the CS was higher (P < 0.05) than in all positions of the GVC. It is possible to pace the atrium independent of the ventricle at reasonably low thresholds and to detect atrial depolarization without undue cross-talk or noise using closely spaced bipolar electrode pairs. The areas of the proximal, middle, and distal CS produced the best combination of pacing and sensing parameters.