ULTRASOUND-GUIDED PERMANENT PACEMAKER IMPLANTATION

To develop the ultrasound-guided technique of endocardial electrode implantation and to compare it with traditional fluoroscopy-guided technique, 60 patients aged 61.4±21.4 years with clinically significant bradycardia were assessed and treated. The patients were distributed into two following groups: the ultrasound-guided procedure was performed in 30 patients of Group I; the commonly accepted fluoroscopy-guided procedure of endocardial electrode implantation was carried out in 30 patients of Group II. Electrodes with passive and active fixation were implanted through a standard surgical access; the electrode location in veins was controlled by ultrasound, if needed. When introducing ventricular electrodes, apical (four chamber view) or subcostal ultrasound access were the most commonly used ones. The ventricular electrode was placed in the apex or basal parts of interventricular septum (IVS); tests were made to confirm stability of the electrode location. For visualization of the ventricular electrode location in the right ventricular apex, modified apical views were most commonly used. The final electrode position was controlled by several echocardiographic views. Transesophageal echocardiography was used in complicated cases of unacceptable visualization. The atrial electrode was located in the right atrium appendage. When introducing the atrial electrode, the apical views (both two-chamber and four-chamber ones) during transthoracic echocardiography were the most commonly used. The fluoroscopy time in the study group was 76.26±4.14 s and in the control group, 204.35±6.06 s. For the last 5 procedures, its duration in both the study and control group became equal; the fluoroscopy time in the study group shrank to 5 s (control fluoroscopy). In 6 cases, tricuspid regurgitation (up to 9 cm2) along the ventricular electrode was revealed during the procedure, which caused the electrode relocation. Thus, the ultrasound-guided implantation of endocardial electrodes can significantly reduce the fluoroscopy time, optimize the intracardiac electrode location, and to find the most optimal location for implantation of a ventricular electrode into IVS.

permanent pacing, endocardial electrodes, tricuspid valve, regurgitation, echocardiography, fluoroscopy

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