His Bundle Pacing: A Look Inside the Beating Heart!
His Bundle Pacing: A Look Inside the Beating Heart!
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他的捆绑节奏：看看跳动的心脏内部！
DOI：
10.1016/j.jacep.2018.12.009
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
K. Ellenbogen
中科院分区：
文献类型：
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作者：
Aditya Saini;V. Kasirajan;J. Koneru;K. Ellenbogen
患者是一名81岁女性，有二尖瓣修复、房颤和使用Select Secure电极导线（型号3830，69 cm; Medtronic Inc.，明尼苏达州明尼阿波利斯），患者表现为进行性呼吸困难和腿部肿胀。患者被诊断为重度三尖瓣返流伴右心室功能障碍，无二尖瓣功能障碍或显著肺动脉高压。她采用微创右胸腔镜入路接受了三尖瓣置换术。图1所示为术前胸部X线片，HBP电极导线位置适当（用星号标记）。12导联心电图显示具有选择性HBP形态的房室顺序起搏，如心室起搏尖峰后的等电间期所证明的，其反映了His起搏-心室间期。手术时，从右心房切开部位观察HBP电极导线。可见明显的三尖瓣环扩张，并显示三尖瓣的间隔、前叶和后叶。HBP电极导线的头端嵌入右心房，位于三尖瓣隔叶上方。在线视频1显示了从心房切开部位观察的HBP电极导线。在选择性HBP患者中，成像和尸检研究先前已证实电极导线头端插入心房时未穿过三尖瓣平面（1 - 3）。即使在非选择性HBP患者中，X线透视评估也显示电极导线头端很少穿过三尖瓣环平面（4）。该病例首次描述了在跳动的非心脏停搏心脏内观察到的HBP电极导线的位置。在该患者中，HBP电极导线在手术过程中无法挽救，植入了心外膜起搏导线。
The patient was an 81-year-old woman with a history of mitral valve repair, atrial fibrillation, and sick sinus syndrome status post–His bundle pacemaker (HBP) implant using a Select Secure lead (model 3830, 69 cm; Medtronic Inc., Minneapolis, Minnesota) who presented with progressive dyspnea and leg swelling. Patient was diagnosed with severe tricuspid regurgitation with right ventricular dysfunction in the absence of mitral valve dysfunction or significant pulmonary hypertension. She underwent tricuspid valve replacement using a minimally invasive right thoracoscopic approach. Figure 1 shows a pre-procedure chest x-ray with appropriately positioned HBP lead (marked by an asterisk). A 12-lead electrocardiogram shows atrioventricular sequential pacing with selective HBP morphology as evidenced by isoelectric interval following ventricular pacing spike, which is reflective of the His bundle–ventricular interval. At the time of surgery, the HBP lead was visualized from the right atriotomy site. Marked tricuspid annular dilatation was seen and septal, anterior, and posterior leaflets of the tricuspid valve are shown. The tip of the HBP lead is seen embedded in the right atrium just above the septal leaflet of the tricuspid valve. Online Video 1 shows the HBP lead as viewed from the atriotomy site. In patients with selective HBP, imaging and autopsy studies have previously demonstrated an atrial insertion of the lead tip without crossing the tricuspid valve plane (1–3). Even in patients with nonselective HBP, fluoroscopic assessments have shown the lead tip to cross the tricuspid annular plane only infrequently (4). This case is the first description of the location of the HBP lead as viewed inside a beating noncardioplegic heart. In this patient, the HBP lead could not be salvaged during the surgery and epicardial pacing wires were implanted.