明確な心内電図波形は,左束の枝領域のペースインプランテーションの際に穿孔を伴う
Heli Tolppanen1,2, Valerian Valiton1, Samuel Stempfel1
1Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, rue Gabrielle Perret Gentil 4, Geneva 1211, Switzerland.
まとめ
左バンドルブランチエリアペース (LBBAP) 穿孔は,損傷の電流 (COI) の振幅の低下を引き起こします. 単極電図 (iEGM) の波形を分析することで,LBBAPのリード展開中に穿孔を特定し,患者の安全性を向上させることができます.
科学分野:
- 心臓病学 心臓病学
- 電気生理学 電気生理学
- 医療機器 医療機器について
背景:
- LEFT BUNDLE BRANCH AREA PECAMING (LBBAP) は,ペーシングの高度なテクニックである.左バンドルブランチエリアペーシング (LBBAP) は,ペーシングの高度なテクニックである.
- LBBAP鉛インプラントの穿孔は合併症を引き起こす可能性があります.
- 単極電図 (iEGM) は,リードの配置中に信号を提供します.
研究 の 目的:
- LBBAP穿孔中の単極iEGM波形を体系的に分析する.
- これらの波形を,最終リードポジションで記録された波形と比較するために.
- 穿孔を示す特定の波形特性を特定するために.
主な方法:
- LBBAPの穿孔を持つ92人の患者からの単極iEGMの分析.
- 穿孔時の損傷電流 (COI) の振幅と波形形態の比較と最終リード位置の比較.
- QRS形態学 (狭い/LBBB以外の対 LBBB/ペースリズム) と穿孔型 (マクロ対マイクロ) に基づいたサブグループ分析.
主要な成果:
- 感知されたCOI振幅は,最終リード位置 (14.0 mV) と比較して,穿孔 (3.0 mV) 時に有意に低かった.
- 狭いQRS/非LBBBを持つ患者はQS波形 (67%) を示し,LBBB/ペースリズムを持つ患者はR/RS形態 (93%) を示した.
- COI振幅よりも大きい感知QまたはS振幅は,狭いQRSサブグループで穿孔を診断するための86%の感度と93%の特異性を有しました.
結論:
- 単極iEGM波形分析は,LBBAP穿孔のCOI振幅を超える追加の診断情報を提供します.
- 特定の波形形状形態 (例えば,狭いQRSでQS) は,穿孔を確実に示すことができます.
- 鉛の配備中にiEGM波形の注意深い監視は,LBBAPの安全性を高めます.
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