普通电极导管经股静脉床旁临时起搏的临床应用

目的:探讨紧急床旁应用普通电极导管经股静脉临时起搏的可行性和有效性.方法:选择2003年10月至2005年10月拟择期安置永久起搏器的严重心动过缓患者32例,男18例,女14例,平均(58±19.3)岁.全部患者均在非透视条件下床旁经股静脉置入普通临时起搏电极导管.达稳定起搏器后,摄床旁X线床头片观察起搏电极导管尖端位置.结果:32例患者行临时起搏均取得成功,成功率100%.安置起搏电极导管所花时间2～12 min,平均(8.3±3.8)min.无一例出现深静脉内血栓形成、心肌穿孔、感染或穿刺并发症.结论:在非透视条件下应用普通电极导管行经股静脉临时心脏起搏安全、便捷、成功率高.适合于紧急床旁临时起搏,避免因患者病情危重,搬动造成生命危险,又同时保护了永久起搏器入路及术区.     

紧急床边心脏临时起搏器植入临床分析

自1960年Fuman开创了经静脉植入电极导管安置心脏临时起搏器以来,心脏临时起搏技术的应用越来越广泛.过去多采用在X线指导下或床旁盲目放置电极导管的方法安装心脏临时起搏器,因需搬运病人,耗时过长及并发症多等原因而延误病人的诊治.本文旨在通过应用漂浮电极导管安置心脏临时起搏器,探讨体表心电图的指导意义.     

球囊漂浮电极床旁紧急心脏临时起搏的应用

经静脉植入心脏临时起搏器是救治严重缓慢性心律失常、心搏骤停的有效手段,尤其是在紧急情况下,球囊漂浮电极床旁紧急心脏临时起搏有着不可替代的治疗作用.而在X线下经静脉植入心脏临时起搏器因需搬动患者、费时等原因,容易延误抢救时机.本研究旨在床旁非X线下使用球囊漂浮电极,经右颈内静脉植入心脏临时起搏器,探讨其应用价值.     

漂浮电极导管在临时心脏起搏器植入术中的应用及技巧

临床上常遇到严重缓慢性心律失常的患者,此时临时心脏起搏是常用的有效抢救手段,安全迅速在床旁植入临时起搏器对救治重症患者至关重要。在无X线的情况下,床旁植入临时起搏器需要应用漂浮电极导管。可经股静脉、锁骨下静脉或颈内静脉途径完成漂浮电极导管的植入,送入导管过程中监测起搏心电图的变化,以心电图的图形变化代替X线,指导漂浮电极导管的放置。     

起搏信号指导床旁临时心脏起搏

自1960年Fuman开创了经静脉植入电极导管安置心脏临时起搏以来,心脏临时起搏技术的应用越来越广泛,过去多采用在X线指导下放置电极导管的方法安置心脏临时起搏器,因需搬动人,耗时过长及并发症多等原因而延误诊治,本文在通过应用普通起搏导管在床旁安置临时起搏器,探讨在心电监护下起搏信号指导临时起搏的可行性及安全性。     

床旁球囊漂浮电极起搏在心脏术后缓慢性心律失常中应用

目的评估心脏外科术后缓慢性心律失常行床旁球囊漂浮电极导管紧急心脏起搏的可行性和有效性。方法心脏外科术后并发缓慢性心律失常患者21例,均给予漂浮电极导管临时起搏治疗,观察临时起搏手术入路、手术时间、电极导管放置部位及起搏阈值,评估治疗成功率和安全性。结果本组起搏器电极安置经右侧锁骨下静脉15例,经右侧颈内静脉6例;手术时间5-12min;电极导管置入右心室心尖部18例,右心室流出道3例;起搏阈值〈1.0mV;床旁球囊漂浮电极起搏治疗成功率100%,发生导管移位、感知起搏不良各2例,无严重并发症发生。结论床旁球囊漂浮电极起搏操作简单,用于治疗心脏术后缓慢性心律失常安全、可行,疗效确切。     

ICU床旁临时起搏器安置术入路及电极的选择

目的:分析我科临时心脏起搏病例,探讨如何快速、安全、简便的安置临时起搏器。方法:21例患者10例应用漂浮电极,11例应用普通电极。11例经左锁骨下静脉入路,其中1例穿刺失败,改经右颈内静脉成功。2例经右颈内静脉入路,9例经右股静脉入路。结果:21例安置均获成功,术中、术后无严重并发症。结论:直接带起搏功能进行操作,利用心电监护心电图示波进行定位,在床旁安置临时起搏器,是一项简单而适用的技术,应用普通电极经左锁骨下静脉通路最快捷,但使用球囊电极经股静脉安置有更高的成功率,可根据需要灵活选择,值得在ICU病房推广。     

床旁应用普通电极导管经右颈内静脉紧急心脏临时起搏54例

2002年7月至2004年2月，作对54例住院或急诊患因不宜搬动或病情危急，在床旁采用普通临时起搏电极，经右颈内静脉紧急临时心脏起搏54例，报道如下。     

心电图引导下紧急床旁临时心脏起搏35例分析

目的：探讨心电图引导下用普通电极导管行紧急床旁临时心脏起搏术的安全性和有效性。方法：35例不同病因所致严重缓慢型心律失常、心脏骤停者,采用非X线条件下,应用普通电极导管,以心腔内心电图引导,体表起搏心电图定位,行紧急床旁临时心脏起搏术。结果：35例患者起搏均获成功,从开始静脉穿刺到完成右心室起搏时间5～20min,平均13min。35例均为右心室起搏,右室心尖部起搏29例,右室流出道起搏5例,右室流人道起搏1例。结论：心腔内心电图引导,体表起搏心电图定位,普通电极导管床旁起搏术是一种效果可靠,操作简便,安全实用的抢救措施,对临床具有重要意义。     

床旁临时起搏治疗缓慢性心律失常22例分析

目的观察严重缓慢性心律失常行紧急床边安装心脏临时起搏器治疗的效果。方法对22例患者采用Seldinger法穿刺锁骨下静脉或股静脉在体表心电图监护及床边超声心动图指引下送入临时起搏电极直到脉冲夺获心室。结果 22例患者中,起搏成功20例,成功率达91%。从开始穿刺到成功起搏的时间为15~35 min,平均起搏阈值为(0.8±0.5)V。1例临时心脏起搏失败,1例患者在临时心脏起搏过程心包填塞死亡。结论应用体表心电图监护及床边超声心动图指引下床边临时心脏起搏治疗严重缓慢性心律失常的技术值得推广应用。     

经锁骨下静脉床旁紧急心脏临时起搏12例分析

目的:总结经左锁骨下静脉插入导管床边紧急心脏临时起搏在急诊抢救中的应用。方法:12例阿-斯综合征、心脏骤停患者在急诊床边经锁骨下静脉插入带指引钢丝临时起搏导管,应用AXQ-3体外起搏器,边起搏边推送电极导管,紧急心脏起搏。结果:12例均起搏成功,达到有效起搏时间为3～9分钟,效果恒定、可靠。结论:该法起效快,疗效肯定,急诊应用,可缩短有效起搏时间,使更多危重者获救。     

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     

Inadvertent Left Ventricle Endocardial or Uncomplicated Right Ventricular Pacing: How to Differentiate in the Emergency Department

Background

Temporary transvenous pacemaker implantation is an important and critical procedure for emergency physicians. Traditionally, temporary pacemakers are inserted by electrocardiography (ECG) guidance in the emergency department because fluoroscopy at the bedside in an unstable patient can be limited by time and equipment availability. However, in the presence of atrial septal defect, ventricular septal defect, and patent foramen ovale, the pacemaker lead can be implanted inadvertently into the left ventricle or directly into the coronary sinus instead of right ventricle. Regular pacemaker rhythm can be achieved despite inadvertent implantation of the pacemaker lead into the left ventricle, leading to ignorance of the possibility of lead malposition.

心电图引导下非漂浮电极床旁心内起搏与起搏复律的临床应用

目的　探讨心电图引导下非漂浮电极床旁心内起搏与起搏复律的效果。方法　用改良的Seldinger方法穿刺左、右锁骨下静脉或右股静脉 ,置入 5F远端塑成直径为 10cmC型非漂浮起搏电极 ,进行床旁起搏和起搏复律。结果　床旁心脏起搏及起搏复律共 10 9例。进行床旁紧急心内起搏或保护性起搏 86例。其中 31例后来在植入埋藏式起搏器时 ,经X光透视证实临床起搏电极在心尖部 30例 ,在流出道 1例。 1例因心脏停搏 ,从右股静脉置入起搏电极进行起搏成功。进行床旁心内起搏复律 2 3例 ,其中室上性心动过速 17例 ,室性心动过速 6例。所有病例起搏及起搏复律成功。结论　心电图引导下非漂浮电极床旁心内起搏与起搏复律具有快速、简便、安全、有效和起搏稳定的优点 ,值得临床推广应用。     

Blind Cannulation of the Left Pericardiophrenic Vein: An Unusual Cause of Diaphragmatic Pacing

Diaphragmatic stimulation as a complication of cardiac pacing due to right ventricular perforation of an endocardial lead or penetration of a screw-in lead along the right atrial free wall, adjacent to the right phrenic nerve, has previously been described. A case of diaphragmatic pacing due to inadvertent insertion of a temporary pacing lead into the left pericardiophrenic vein via the left internal jugular vein is presented and anatomical considerations are discussed.     

无X线指导紧急临时心脏起搏治疗重症慢性心律失常24例临床观察

对24例急性重症缓慢性心律失常合并严重血流动力学障碍患者进行无X线指导下床旁紧急临时心脏起搏治疗，以体表心电图和边进导管边起搏的方法判断起搏情况及电极的位置。结果成功起搏22例，成功率gi．7％。本文还对其临床意义及并发症的预防进行了讨论。     

Temporary transvenous pacemaker placement in the Emergency Department

Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated. The indications for the procedure, as well as the equipment needed, are reviewed. Both blind and ECG-guided techniques of insertion are described. Methods of verification of pacemaker placement and function are discussed, as are the early complications of the procedure.     

Esophageal Balloon Electrode Catheter for Transthoracic Recording of His-Bundle Potential with Transesophageal Atrial Pacing

To evaluate the influence of transesophageal atrial pacing of the transthoracic His potential identification, we combined signal-averaged ECG with transesophageal atrial pacing with low threshold for pacing averaging ECG recording. A tripolar 10 French esophageal balloon electrode catheter, with one cylindrical electrode on the tip of the catheter and two balloon electrodes on the cardiac side of the catheter, used in 53 patients, allowed a painless transesophageal atrial pacing and a high signal to noise distance in the signal-averaged ECG. Transesophageal atrial pacing allowed in 37 of 53 patients an identification of His potential by increasing the distance between the end of the atrial potential and the onset of the His potential in the pacing averaging ECG. The esophageal balloon electrode catheter allowed a painless transesophageal atrial pacing with low threshold for atrial capture during a long pacing time and a high signal to noise distance in the pacing averaging ECG. The increasing of the heart rate with transesophageal atrial pacing allowed the transthoracic identification of the His potential in the pacing averaging ECG.     

Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure

This article describes a new technique of LV lead insertion, using transseptal catheterization performed through the right internal jugular vein, to obtain a totally endocardial biventricular chronic pacing in end-stage heart failure. Three patients with QRS widening (> 180 ms) linked to complete left bundle branch block (n = 2) or right ventricular pacing (n = 1) were included in this preliminary study. Catheterization was performed under fluoroscopy and transesophageal echocardiography guidance. Transseptal catheterization was achieved by puncture of the right internal jugular vein at the base of the neck and by using a Brockenbrough needle, the tip curve of which was more curved than the standard model. A flexible long sheath was advanced in the left atrium through the interatrial septum and then a unipolar electrode was placed easily in the LV. The proximal tip of the LV lead was tunneled from the neck to the subclavian area and connected to the ventricular channel of a dual (n = 1) or simple (n = 2) chamber pacemaker. Efficient acute sensing (V wave amplitude = 13 +/- 3 m V) and pacing (acute pacing threshold = 0. 7 +/- 0.4 V) were obtained in the three patients. Early loss of capture occurred in two patients requiring lead replacement. Functional status dramatically improved in all three patients. At 6-month follow-up, biventricular pacing was maintained in all patients (mean threshold 1.4 V) who were free of clinical embolic event with oral anticoagulation therapy. This modified technique of jugular transseptal catheterization appears promising for the development of left heart pacing.