It is useful for the diagnosis of patients with some disorders of atrial rhythm and the screening of treatment options. But how its vitality remains to be further researched and tested in time.
The muscle sleeve electrical isolation of 6 patients with paroxysmal atrial fibrillation was also broadcast live during the meeting. All the operations met the immediate success criteria of electrical isolation, which made the representatives further enhance their confidence in the maturity and reliability of this method. Finally, the participants unanimously recommended that several large paroxysmal atrial fibrillation research and development groups be established nationwide, and that a paroxysmal atrial fibrillation could be established with reference to different research methods and ablation endpoints. Case library. Therefore, the research work of paroxysmal atrial fibrillation can be further strengthened, which is conducive to obtaining phased research results more quickly and accurately, and is conducive to enhancing China's international status in the field of electrophysiology.
(:2002-09~10) (Editor: Xu Shijie). Experience and lessons.
The screw of the fixed wire during the implantation of the permanent cardiac pacemaker is removed from the case of a permanent cardiac pacemaker during the implantation of a residual cardiac pacemaker. It is often necessary to release the fixed wire and the pulse generator. In the process of loosening, it is rare to remove the screw of the fixed wire from the pulse generator, but if it is not handled properly, it will cause damage to the pacemaker. In the work, the screw of the fixed wire on the pulse generator was disengaged, and the wire could not be fixed. After correct treatment, a permanent cardiac pacemaker was successfully implanted.
The patient, male, 45 years old, was admitted to hospital on March 19, 2002 due to episodes of palpitations and chest tightness for 6 years. There is a history of paroxysmal dizziness without syncope. A history of previous hypertension for more than 10 years. Physical examination body temperature 36.4 * C, pulse 45 times / min blood pressure 145 / 90mmHg (1mmHg = 0.133kPa) breathing 18 times / min - good condition, conscious, lungs breath sound clear, not smelling dry, wet sound, heart The left lower part of the boundary enlarges the unseen and pathological murmur of each valve E, and the edema of the lower limbs is not touched under the liver and spleen. Conventional ECG showed paroxysmal atrial tachycardia (heart rate 170 beats / min) sinus bradycardia (40 times / min) ECG monitoring showed sinus bradycardia paroxysmal atrial tachycardia, sinus stop The heart color echocardiography showed a significant enlargement of the left ventricle, and the wall motion was generally reduced. The left ventricular ejection fraction was 0.46. There was no abnormality in coronary angiography. The clinical diagnosis is dilated cardiomyopathy, sick sinus syndrome, hypertension. A permanent cardiac pacemaker was implanted in the catheterization room on March 25, 2002. Medtronic's SigmaSDR303 pulse generator atrial and ventricular leads were Medtronic Capsure SP4023 and Capsure SP4523 monopolar wires, respectively. The atrial lead was implanted into the right atrial appendage and the ventricular lead in the right ventricle through the subclavian vein. After testing various parameters, the atrial and ventricular leads were fixed respectively. The pulse generator was turned on and the pulse generator was confirmed to be undamaged. The atrial and ventricular leads were Connect the pulse generator. Tighten the screws of the fixed wire with a special screwdriver. After confirming that the wire is firmly connected to the pulse generator, place the pulse generator into the subcutaneous pocket. After the pacemaker works normally in DDD mode, prepare the skin layer by layer. Conventional fluoroscopy is used to understand the position of the wire and it is found that the atrial wire is too tight and may be pulled outward during the fixation process. Then take out the pulse generator, use a special screwdriver to loosen the room wire, and reposition the atrial wire to the satisfaction. The atrial wire was again connected to the pulse generator. When the screw of the wire was fixed with a screwdriver, it was found that the screwdriver lost resistance when it was rotated in the clockwise direction, and the wire could not be firmly connected with the pulse generator. Through careful observation of the transparent side end and the back of the pulse generator, it was found that the screw and the nut port were completely separated, and the screw was lying on the port, so that the screw could not enter the nut, and the screwdriver could not be inserted into the 6-angle groove at the top of the screw. Carefully remove the sealed silicone with an ophthalmic tweezers and slowly remove the screws by clamping them. Check that the screw is intact. First, put the screw on the screwdriver, then insert the nut into the nut port in the vertical direction. Gently rotate the screwdriver clockwise. Observe the screw through the transparent side end and correctly enter the nut. Tighten the screw and hear “哒, 哒. After the wire is firmly connected to the pulse generator, the pulse generator is implanted, and the pacemaker operates in DDD mode. The pacemaker function was normal after the follow-up.
The situation that the screw is separated from the pulse generator has not been reported at home and abroad. The reason for the analysis may be (1) during the production process of the pulse generator, there is a bubble between the filling rubber and the screw at the fixing screw, so that there is an excessive gap between the filling rubber and the screw; (2) the process of releasing the wire In the middle, the counterclockwise rotation is repeated, so that the screw and the nut are completely separated. Due to the gap between the filler and the screw, the screw changes direction and lies on the nut port. In this case, the treatment must be very careful, otherwise the pacemaker will need to be replaced once the screw is damaged or lost. Our experience is (1) If the screw is separated from the nut and the wire cannot be fixed, the screw must be removed and then re-inserted into the nut. It is not easy to blindly adjust the direction of the screw in the filling glue, and the screwdriver is difficult to insert accurately into the 6-corner groove at the top of the screw; (2) Since the screw is very small, it is necessary to move the screw when removing the screw to avoid the screw popping out. Once the screw pops out of the worker's line of sight, it will be difficult to find; () the removed screw should be placed on the screwdriver first, inserted into the nut with the screwdriver, and then turn the screwdriver clockwise until the screw is screwed into the nut.
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