起搏器植入技术.pptVIP

* * 可能会导致患者起搏器的房颤 * * * PA and Lateral Chest X-ray - Lead placement This patient has a dual unipolar DDD pacing system. Both leads were inserted via the left cephalic vein. The atrial lead is directed anteriorly on the lateral and angled medially high within the cardiac silhouette. The ventricular lead is located in the RV apex. This is not quite to the outer wall of the heart as this would be LV and indicate perforation. The apex of the RV is often below the level of the diaphragm. On the anterior view, a lead located n the RV apex is directed anteriorly. * * 主动导线可以先不旋出直接测试，测试合格后再固定 心室上旋出8-10圈，心房上旋出10-12圈 * * * * * * * * * * * * * * * * * * * * * * * * * * Implantation from the right side In case that patient is right handed the musculature on the right side of tht thorax and the veines can be more pronounced that on the left side. This can facilitate the implantation of the lead(s). The usual surgical arrangements of implanter and assisatnt and the fact that for an implanter the right side approach is more convenient lead to right side implantation Implantation from the right side: Especially in patients that perform physical work with their right hand (craftsmen, hunters) left sided implantation should be preferred. Abdominal implantation : very rarely, today pacemakers are small, lightweight and thin. Only in rare cases if the patient is a child and otherwise very thin. * * 锁骨下静脉外1/3处 * * Pacemaker implantation can be performed either from the right side or from the left side. There is no difference in principle. It may depend on the patient’s preference. The right sided approach demands a double curve. The left sided approach allows for an unidirectional curve. * It depends on the preference of the implanting physician whether the cephalic cut down is used as the mode of entry, or the subclavian puncture technique. Subclavian puncture is addressed here. In anatomic drawings the course of the subclavian is fairly straight. In real life, in t