心房起搏电极的位置选择.pptVIP

* * P wave duration two weeks after implant during sinus rhythm and atrial pacing in patients with atrial leads in Bachmann’s bundle region (n=60) versus the right atrial appendage. *P , 0.05 vs. via paired t-test. ?P , 0.05 via one-way ANOVA on ranks with Dunn’s adjustment for multiple comparisons. * * This trial studied 120 patients with paroxysmal AF history and brady pacing indication in two groups: RAA vs. high atrial septum (Bachmann’s Bundle). The primary endpoint was survival free from chronic AF (clinical definition). (BB 75%; RAA 47%) * Modified J stylet is a slightly opened J compared to astandard J-tip stylet. This position allows greater reach for septallead placement. * A: Bachmann bundle in the left anterior oblique view. The x-ray tube angle is adjusted to make the right ventricular lead foreshortened so that the septal plane is parallel to the camera plane. The atrial septum lies roughly along the right ventricularseptal plane * Left anterior oblique view of a Bachman bundle leadthat is “overtorqued” with the electrode bipole at the atrial roof * B: The right anterior oblique view is adjusted so that the right ventricular lead is fully seen and its longitudinal axis is perpendicular to the camera plane. A lead placed at Bachmanbundle will be pointed anteriorly and above the tricuspid valve. * Koch三角兴奋性较高，且传导速度较慢，是兴奋性增高性房性心律失常的常见起源灶，也是折返性房性心律失常的关键部位 * 如果把冠状窦- 左房看成一个钟面，冠状窦口在6 点位置，电极头端如果位置恰当应该在12 点位置。 * (a) Fluoroscopic images of the position of the right atrial appendage (RAA) lead. The frontal view in the left panel and a left anterior-oblique 45° angulation in the right panel, where the RAA lead is directed superior and anterior. RAA = right atrial appendage, LAO = left anterior oblique. (b) Fluoroscopic images of the position of the low atrial septum (LAS) lead. The frontal view in the left panel and a left anterior-oblique 45° angulation in the right panel, where the LAS lead is directed at 90° angles at the inter atrial septum. LAS = low