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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Right ventricular outflow tract pacing: radiographic and electrocardiographic correlates of lead position.
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Right ventricular outflow tract pacing: radiographic and electrocardiographic correlates of lead position.

机译：右心室流出道起搏：导联位置的射线照相和心电图相关性。

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OBJECTIVE: To characterize the pacing site in an unselected series of patients undergoing right ventricular outflow tract (RVOT) lead placement and investigate the role of the electrocardiogram (ECG) in predicting implantation. BACKGROUND: Right ventricular apical pacing is associated with long-term adverse effects on left ventricular function, fuelling interest in alternative pacing sites, especially the RVOT. Previous studies have been conflicting, possibly due to poor definition of pacing site within the RVOT. METHODS: In 150 patients undergoing pacemaker implantation, implanters were asked to place the lead in the RVOT. Radiographs were performed in the antero-posterior (AP) and 40 degrees right and left anterior-oblique projections post procedure. Fifty-six had left lateral radiographs. Lead position was categorized using AP/RAO (right anterior oblique) to confirm RVOT placement and left anterior oblique to distinguish free wall from septum. A 12-lead ECG was performed during ventricular pacing. RESULTS: Leads were below the RVOT in 18. Of the remaining 132, the majority (94%) were in the inferior/low RVOT. Eighty-one out of 132 were septal and 51 free wall. Septal sites were associated with shorter QRS duration (134 ms vs 143 ms, P < 0.02). Free wall sites displayed more frequent notching of the inferior leads (P < 0.01). A negative deflection in lead I provided a positive predictive value of 90% for septal sites. In those with lateral radiographs, a posteriorly projected lead was 100% specific for septal placement. CONCLUSIONS: This study demonstrates the heterogeneity of lead placement within the RVOT. Septal and free wall sites display characteristic ECG patterns which may be used to aid placement. The left lateral radiograph is useful in confirming a true septal location.
机译：目的：鉴定未选择的一系列右室流出道（RVOT）导联放置患者的起搏部位，并研究心电图（ECG）在预测植入中的作用。背景：右心室心律起搏与对左心室功能的长期不良影响相关联，加剧了人们对替代性起搏部位（尤其是RVOT）的兴趣。先前的研究存在冲突，可能是由于RVOT中的起搏部位定义不清。方法：在150名接受起搏器植入的患者中，要求植入器将导线置于RVOT中。术后分别在前后（AP）和右，左前斜投影40度进行X光片检查。五十六名患者已拍摄了左侧X光片。使用AP / RAO（右前斜肌）对导联位置进行分类，以确认RVOT位置，左前斜肌以区分游离壁与隔膜。心室起搏期间进行12导联心电图。结果：18个中的铅低于RVOT。在其余132个中，大多数（94％）处于RVOT下/低。 132个中的81个是隔室和51个自由壁。间隔部位的QRS持续时间较短（134 ms vs 143 ms，P <0.02）。游离壁部位显示出次品铅的切口更频繁（P <0.01）。铅I的负偏转为隔垫部位提供了90％的正预测值。在有侧位X线照片的患者中，后凸铅对于间隔放置具有100％的特异性。结论：这项研究证明了RVOT中铅放置的异质性。隔墙和游离墙部位显示出特征性的ECG模式，可用于辅助放置。左侧X光片可用于确认真正的间隔位置。

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