背景:在透视下定位传导系统并不容易,生理起搏中起搏导线的理想位置仍在争论中。
目的:主要目的是使用心脏CT扫描评估导线位置。次要目标是临床结果,包括手术的成功和安全性以及导线性能。
方法:在接受生理起搏的100名连续患者中,34例患者接受了随访心脏CT扫描。四种不同类型的起搏被确定为希氏束(HBP),para-Hisian,左束支(LBBP),深间隔起搏.
结果:与右心室(RV)(12.5%)相比,大多数患者通过右心房(RA)成功HBP(87.5%)。当导线放置在膜和肌性室间隔交界处的2mm内时,观察到较低的阈值。不像HBP,LBBP在隔膜的较宽区域是可能的,并且可以选择性捕获单个束。LBBP显示引线更深地渗透到隔膜中,与深间隔起搏相比(70%与45%)。大约,80%的患者没有膜间隔的心室内部分。
结论:房室(AV)间隔的前部在膜和肌间隔之间的交界处通过RA似乎是成功起搏His束的最佳目标。LBBP在隔膜的较宽区域是可能的,并且可以选择性捕获单个束。足够的铅穿透深度对于捕获左束非常重要。
BACKGROUND: Localisation of the conduction system under fluoroscopy is not easy and the ideal location of the pacing leads in physiological pacing is still being debated.
OBJECTIVE: The primary aim was to assess the lead locations using cardiac CT scan. Secondary aims were clinical outcomes including success and safety of the procedure and lead performance.
METHODS: Of the 100 consecutive patients who received physiological pacing, 34 patients underwent follow-up cardiac CT scan. The four different types of pacing were identified as His bundle (HBP), para-Hisian, left bundle branch (LBBP), and deep septal pacing.
RESULTS: Most patients had successful HBP via the right atrium (RA) (87.5%) as compared to the right ventricle (RV) (12.5%). Lower thresholds were observed when leads were placed within 2 mm of the junction of the membranous and muscular ventricular septum. Unlike HBP, LBBP was possible at a wide region of the septum and selective capture of individual fascicles was feasible. LBBP showed deeper penetration of leads into the septum, as compared to deep septal pacing (70% vs. 45%). Approximately, 80% of patients did not have an intra-ventricular portion of the membranous septum.
CONCLUSIONS: The anterior part of the atrio-ventricular (AV) septum at the junction between the membranous and muscular septum via RA appeared to be the best target to successfully pace His bundle. LBBP was possible at a wide region of the septum and selective capture of individual fascicle was feasible. Adequate depth of penetration of lead was very important to capture the left bundle.