Routine Usage of Epicardial Leads in the Everyday Practice

Анотація

Despite the dominance of transvenous approach alternative methods of ECS could be attractive if they provide several advantages, i.e. if they are fast, inexpensive and not connected with X-ray burden. Vast developing countries could especially take an interest in ECS procedures applicable in local hospitals thus avoiding prolonged transportation of the patients to cardiac centres. We are studying these concepts about 20 years choosing after comparative studies extrapleural pericardioscopy. Under general anesthesia the electrodes were delivered through subxyphoidal approach using a rigid pericardioscope with diameter 2 cm. With this approach every chamber of the heart is accessible for pacing. All electrodes due to availability were of screw-in type. As the endoscope equipment is portable and the method not need X-ray control the pacing could be performed in any local hospital by a flying team of specialists. Our experience with pericadioscopic straight electrode implantations mainly for standard VV I [86%] and AAI pacing [13%] exceeds 1060 cases. 131 patients [12.5%] had been operated in local hospitals by the flying team. Especially impressive was stability of electrodes: dislocation rate was 0%. There were no serious complications related with the implantation method. Recently we are focused on LV pacing [28 cases] and resynchronisation therapy [8 cases]. In the both groups immediate LV pacing was achieved in 95.3%. In the rest patients RV instead of LV stimulation occurred which required immediate reimplantation with success in all cases. Techniques of straight pericardioscopic extrapleural implantations of pacemaker electrodes could be a part of everyday practice especially for LV stimulation and if necessary to perform ECS on the spot in local hospitals.

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