导电球囊电极导管经食管心室起搏的临床应用
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摘要
目的 采用导电球囊电极导管进行经食管心室起搏，评价其可行性、安全性及临床应用效果，为导电球囊电极导管的临床应用提供可靠依据，使经食管心室起搏法在临床上得以推广应用。
方法 选择60例需做经食管心脏起搏电生理检查和诊治的病人，采用导电球囊电极导管进行经食管心室起搏，记录插管深度、起搏阈值、心室有效不应期(VERP)以及插管和起搏时病人的反应程度，并与普通金属环电极导管结果进行比较。用导电球囊电极导管对60例病人中的10例室速病人进行电生理检查，观察室性心动过速的诱发和终止情况。用导电球囊电极导管对5例因Ⅲ度房室传导阻滞需行临时心脏起搏的病人进行经食管临时心室起搏，观察其效果。
结果(1)导电球囊电极导管经食管心室起搏的起搏阈值明显低于普通金属环电极导管(t=18.16，P＜0.01)；(2)导电球囊电极导管经食管心室起搏的成功率明显高于普通金属环电极导管(X~2=22.54，P＜0.01)。(3)两种导管所测心室有效不应期相比较，差异无统计意义(P＞0.05)。(4)分别用两种导管插管时，病人出现中度和重度反应的例数比较，差异无统计意义(P＞0.05)；两种导管的插管深度比较，差异无统计意义(P＞0.05)。(5)用导电球囊电极导管起搏时，病人出现中度和重度反应的例数明显低于普通金属环电极导管起搏时(中度：X~2=28.23，P＜0.01；重度：X~2=7.21，P＜0.01)。病人出现轻度反应的例数明显高于普通金属环电极导管起搏时(X~2=52.46，P＜0.01)；经食管心室起搏的起搏电压与病人反应程度的等级呈正相关(τ值为0.666，P＜0.01)。(6)两种导管对室性心动过速的诱发成功率的差异无统计意义(P＞0.05)。(7)用导电球囊电极导管对5例病人进行临时心脏起搏，均顺利完成。
结论 (1) 导电球囊电极导管的球囊电极经充气后面积可达22cm~2，与食管接触面积增大，贴附性良好，有利于经食管心室起搏。(2) 应用导电球囊电极导管进行经食管心室起搏，所需起搏阈值较普通金属环电极导管低，且起搏成功率高。(3)两种导管经食管心室起搏电生理检查所得参数无差异，诊断一致。(4) 在进行经食管心室起搏过程中，病人的不适感程度随起搏电压的增加而增加。应用导电球囊电极导管起搏所需电压低，病人的不适感轻、易耐受。(5)用导电球囊电极导管可以对室性心动过速进行经食管电生理检查；还可以顺利完成经食管临时心脏起搏。(6)
中文摘要
导电球囊电极导管经食管心室起搏是一种无创的、安全的、有效的电生理检查方法。
Objective To study the effect of transesophageal ventricular pacing by using a novel electric balloon electrode catheter.
Methods With the new electric balloon electrode catheter, 60 cases were performed transesophageal ventricular pacing(TEVP) and recorded the depth of catheter, average volt, VERP and the response of patients. The results were compared with that of ordinary loop electrode catheter. 10 cases with ventricular tachycardia(VT) were performed electrophysiological examination by electric balloon electrode catheter, and recorded the condition of VT. The results were compared with that of ordinary loop electrode catheter. 5 cases with III degree atrioventricular block were performed transesophageal ventricular pacing through electric balloon electrode catheter.
Results (1) In the electric balloon electrode catheter group, the average volt was significantly lower than that of ordinary loop electrode catheter group(t=18.16, PO.01). (2) In the electric balloon electrode catheter group, the success rate was significantly higher than that of ordinary loop electrode catheter group(X2=22.54, PO.01). ㎞o significantly difference in the depth of catheter and VERP between two groups(P>0.05). (4)No significantly difference in the depth of catheter and the response of patients while inserting catheter between two kind of catheters(P>0.05). (5) While TEVP with electric balloon electrode catheter, the quantity of patients who have moderate and server response were significantly fewer than that of ordinary loop electrode catheter group(Moderate: X2=28. 23, P<0. 01; Server :X2=7. 21, P<0. 01), the cases who have mild response was significantly more than that of ordinary loop electrode catheter group(X2=52. 46, P<0. 01). The degree of patients' response was positively correlated wi
th pacing volt( =0. 666, P<0. 01). (6) No significantly difference in the occurrence of VT between two kind of catheter group(P>0.05). (7) 5 cases with III degree atrioventricular block were performed transesophageal ventricular pacing successfully through electric balloon electrode catheter.
Conclusions (1) The electric balloon electrode could be expanded by filling gas and the area of expanded electric balloon electrode had 22cm2, the area which contact esophagus is larger. (2) With the new electric balloon electrode catheter, the success rate of TEVP was elevated and the average volt was decreased. (3) Electrophysiological parameter was coincidence by two kinds of catheter. (4) The degree of patients' response was positively correlated with pacing volt. (5)The electrophysiolsgical examination can
be performed by the electric balloon electrode catheter. The electric balloon electrode catheter also can be used to temporary cardiac pacing. (6) Transesophageal ventricular pacing(TEVP) by new electric balloon electrode catheter is a non-invasive, safe and effective method.
方法 选择60例需做经食管心脏起搏电生理检查和诊治的病人，采用导电球囊电极导管进行经食管心室起搏，记录插管深度、起搏阈值、心室有效不应期(VERP)以及插管和起搏时病人的反应程度，并与普通金属环电极导管结果进行比较。用导电球囊电极导管对60例病人中的10例室速病人进行电生理检查，观察室性心动过速的诱发和终止情况。用导电球囊电极导管对5例因Ⅲ度房室传导阻滞需行临时心脏起搏的病人进行经食管临时心室起搏，观察其效果。
结果(1)导电球囊电极导管经食管心室起搏的起搏阈值明显低于普通金属环电极导管(t=18.16，P＜0.01)；(2)导电球囊电极导管经食管心室起搏的成功率明显高于普通金属环电极导管(X~2=22.54，P＜0.01)。(3)两种导管所测心室有效不应期相比较，差异无统计意义(P＞0.05)。(4)分别用两种导管插管时，病人出现中度和重度反应的例数比较，差异无统计意义(P＞0.05)；两种导管的插管深度比较，差异无统计意义(P＞0.05)。(5)用导电球囊电极导管起搏时，病人出现中度和重度反应的例数明显低于普通金属环电极导管起搏时(中度：X~2=28.23，P＜0.01；重度：X~2=7.21，P＜0.01)。病人出现轻度反应的例数明显高于普通金属环电极导管起搏时(X~2=52.46，P＜0.01)；经食管心室起搏的起搏电压与病人反应程度的等级呈正相关(τ值为0.666，P＜0.01)。(6)两种导管对室性心动过速的诱发成功率的差异无统计意义(P＞0.05)。(7)用导电球囊电极导管对5例病人进行临时心脏起搏，均顺利完成。
结论 (1) 导电球囊电极导管的球囊电极经充气后面积可达22cm~2，与食管接触面积增大，贴附性良好，有利于经食管心室起搏。(2) 应用导电球囊电极导管进行经食管心室起搏，所需起搏阈值较普通金属环电极导管低，且起搏成功率高。(3)两种导管经食管心室起搏电生理检查所得参数无差异，诊断一致。(4) 在进行经食管心室起搏过程中，病人的不适感程度随起搏电压的增加而增加。应用导电球囊电极导管起搏所需电压低，病人的不适感轻、易耐受。(5)用导电球囊电极导管可以对室性心动过速进行经食管电生理检查；还可以顺利完成经食管临时心脏起搏。(6)
中文摘要
导电球囊电极导管经食管心室起搏是一种无创的、安全的、有效的电生理检查方法。
Objective To study the effect of transesophageal ventricular pacing by using a novel electric balloon electrode catheter.
Methods With the new electric balloon electrode catheter, 60 cases were performed transesophageal ventricular pacing(TEVP) and recorded the depth of catheter, average volt, VERP and the response of patients. The results were compared with that of ordinary loop electrode catheter. 10 cases with ventricular tachycardia(VT) were performed electrophysiological examination by electric balloon electrode catheter, and recorded the condition of VT. The results were compared with that of ordinary loop electrode catheter. 5 cases with III degree atrioventricular block were performed transesophageal ventricular pacing through electric balloon electrode catheter.
Results (1) In the electric balloon electrode catheter group, the average volt was significantly lower than that of ordinary loop electrode catheter group(t=18.16, PO.01). (2) In the electric balloon electrode catheter group, the success rate was significantly higher than that of ordinary loop electrode catheter group(X2=22.54, PO.01). ㎞o significantly difference in the depth of catheter and VERP between two groups(P>0.05). (4)No significantly difference in the depth of catheter and the response of patients while inserting catheter between two kind of catheters(P>0.05). (5) While TEVP with electric balloon electrode catheter, the quantity of patients who have moderate and server response were significantly fewer than that of ordinary loop electrode catheter group(Moderate: X2=28. 23, P<0. 01; Server :X2=7. 21, P<0. 01), the cases who have mild response was significantly more than that of ordinary loop electrode catheter group(X2=52. 46, P<0. 01). The degree of patients' response was positively correlated wi
th pacing volt( =0. 666, P<0. 01). (6) No significantly difference in the occurrence of VT between two kind of catheter group(P>0.05). (7) 5 cases with III degree atrioventricular block were performed transesophageal ventricular pacing successfully through electric balloon electrode catheter.
Conclusions (1) The electric balloon electrode could be expanded by filling gas and the area of expanded electric balloon electrode had 22cm2, the area which contact esophagus is larger. (2) With the new electric balloon electrode catheter, the success rate of TEVP was elevated and the average volt was decreased. (3) Electrophysiological parameter was coincidence by two kinds of catheter. (4) The degree of patients' response was positively correlated with pacing volt. (5)The electrophysiolsgical examination can
be performed by the electric balloon electrode catheter. The electric balloon electrode catheter also can be used to temporary cardiac pacing. (6) Transesophageal ventricular pacing(TEVP) by new electric balloon electrode catheter is a non-invasive, safe and effective method.
引文
1．汪明觉 无创性心室起搏 心血管病学进展 1989；10(1)：24-26
2．张杰，庄亚纯 应用食管心房起搏评价动态心电图中缓慢性心律失常 中华心律失常学杂志 2000(9)；4(3)：206-207
3. Schwann NM, Maguire DE et al. Evaluation of transesophageal atrial pacing in the prone and lateral positions. J Cardiothroac Vasc Anesth 2001(4); 15(2): 192-6
4. Kesek M, Sheikh H, et al. The sensitivity of transesophageal pacing for screening in atrial tachycardias. Int J Cardiol 2000(2); 15; 72(3): 239-42
5．郑方胜 经食管心室起搏导电球囊电极导管[P]．中国专利：ZL97101311．Ⅹ 2002．12．11
6．周德麟 经食管心室起搏方法学研究初步报告 心电学杂志 1987；6(3)：157
7．郑方胜，主编 经食管心室起搏 经食管心脏起搏与电复律 第一版，青岛：青岛海洋大学出版社 1998：166-171
8. Cremer M. Uber die direkte ableitung der aktionsstrome des menserrlichen herzens vom osesophagus und uber das elektrokaradiogramm des fetus. Munch Med Wochenschr 1906; 53: 811
9. Brown WH. A study of the esophageal lead in clinical electrocardiography. Part Ⅰ. The application if the esophageal lead to the human subject with observations on the Ta-wave, extrasystoles and bundle-branch block. Am Heart J, 1936; 12: 1-45
10. Brown WH. A study of the esophageal lead in clinical electrocardiography. Part Ⅱ. An electrocardiographic study of auricular disorders in the human subject by means of the esophageal lead. Am Heart J, 1936; 12: 307-38
11. Zoll PM. Resuscitation of the heart in ventricular standstill by external electrical stimulation. JAMA 1952; 247: 768
12. Burack B, Furman S. Transesophageal cardiac pacing Am J cardiol 1969; 23: 469
13. Montoyo JV, Angel J, Valle V, et, al Cardioversion of tachycardias by transesophageal atrial pacing Am J cardiol 1973; 32: 85
14．蒋文平，汪康平，等．经食管心房调搏结合固有心率测定评定窦房结功能．中华内科学杂志，1982，21：22
15. John J. Esophageal Pacing: A Diagnostic and Therapeutic Tool. Circulation, 1982; No2: 336-341
16．赵龙生，等．房室折返性心动过速逆行P波的心电图特征及其在旁道定位中的价值．中国心脏起博与心电生理杂志．1996；10(1)：28-29．
17．郑方胜，等．射频消融前经食管心房调搏检查对阵发性室上速的诊断价值．山东医药 2003；43(4)：15-17
18. Anderson HR, Pless P. Transesophageal pacing PACE 1983; 6: 674-679
19. Gallagher JJ, Smith WM, et,al. Esophageal pacing: A diagnostic and therapeutic tool Circulation 1982; 65: 336-341
20．周德麟 经食管心室起搏方法学研究初步报告 心电学杂志 1987；6(3)：157
21. Beson DW, Durmigan A, Benditt DG, et al. Transesophageal cardiac pacing history, application, technique. Clin Prog Pacing Electrophysiol, 1984; 2: 360-72
22. Shafiroff BGP, Linder J. Effects of external electrical pacemaker stimuli on the human heart. J Thorac Surg, 1957; 33: 544-50
23．沈剑清 新型食管心脏调搏电极导管的研制与应用 中国心脏起搏与心电生理杂志 1999；13(4)：201-204
24. David J. Cochrane. An esophageal and Gastric Approach to Ventricular Pacing. PACE, 1995(1); Part Ⅰ: 28-33
25. Pascal P, Mekeown J, et al. Transesophageal cardiaoversion. Am Heart J, 1993; 125: 399-403
26．朱德福．食管定向弯曲电极导管起搏、除颤及监护功能的实验研究．心脏起搏与电生理杂志 1994；8(3)：154-156
27．孙瑞龙，黄宛主编 心室性快速心律失常 临床心电图学 第五版 北京：人民卫生出版社 2001：371-396
28．李忠成 主编 室性心动过速 导管消融治疗学 第一版 天津：天津科学技术出版社 1995：212
29 Wiener I. Current applications of clinical electrophysiologic study in the diagnosis and treatment of cardiac arrhythmia. Am J Cardiol. 1989; 49(1): 1287
30. Waldo AL. Temporary cardiac pacing: Applications and techniques in the treatment of cardiac arrhythmias. Prog Cardiovas Dis. 1981; 23(6): 451
31. John D. Termination of ventricular tachycardia with bursts of rapid ventricular pacing. Am J Cardiol. 1978; 47(1): 94-101
32. Volkmann H. Termination of tachycardias by transesophageal electrical pacing. PACE 1992; 15(9); Part Ⅱ: 1962-66
33. Mceneaney D. A gastroesophageal electrode for electrophysiological studies. PACE; 1999; 22(3): 487-499
34．周德麟．经食管心室调搏终止顽固性阵发性室性心动过速．心电学杂志 1989；8(3)：138-140
35．黄捷英．经食管心室起搏诊断及终止室速的相对功效观察 心电学杂志 1993；12(3)189-191
36. Vandepol CJ, et al. Incidence and clinical significance of induced ventricular tachycardia. Am J cardiol 1980; 45: 725
37. Livelli FD Jr, et al. Response to programmed ventricular stimulation: sensitivity, specificity and relation to heart disease. Am J cardiol 1982; 50: 452
38．朱玉岑，等．经食管心室起搏成功抢救反复心脏停搏一例．首都医学院学报 1993；14(1)：59-61
39. Sadowski, LM, Et al. Amiodarone for control of sustained ventricular tachyarrhythmia: clinical and electrophysiologic effects in 51 patients. Am J Cardiol. 1982; Nov; 50(5): 1066-74.
40．Crawford. MH主编 室性心动过速 现代心脏病学诊断与治疗 第一版 北京：人民卫生出版社 2003：321-337
41．陈仕章 经食管心室起搏治疗完全性房室传导阻滞、尖端扭转型室速室颤3例．实用医学杂志 1999；15(5)：349
42．王翔，冯国定．改良食管起搏导管在心脏骤停心室起搏中的应用 心电学杂志 2000；19(3)：160-161
43．刘少波，刘华荣．胃食管电极心室起搏抢救心脏性猝死的临床应用 中国临床医学 2001；8(2)：113-114
2．张杰，庄亚纯 应用食管心房起搏评价动态心电图中缓慢性心律失常 中华心律失常学杂志 2000(9)；4(3)：206-207
3. Schwann NM, Maguire DE et al. Evaluation of transesophageal atrial pacing in the prone and lateral positions. J Cardiothroac Vasc Anesth 2001(4); 15(2): 192-6
4. Kesek M, Sheikh H, et al. The sensitivity of transesophageal pacing for screening in atrial tachycardias. Int J Cardiol 2000(2); 15; 72(3): 239-42
5．郑方胜 经食管心室起搏导电球囊电极导管[P]．中国专利：ZL97101311．Ⅹ 2002．12．11
6．周德麟 经食管心室起搏方法学研究初步报告 心电学杂志 1987；6(3)：157
7．郑方胜，主编 经食管心室起搏 经食管心脏起搏与电复律 第一版，青岛：青岛海洋大学出版社 1998：166-171
8. Cremer M. Uber die direkte ableitung der aktionsstrome des menserrlichen herzens vom osesophagus und uber das elektrokaradiogramm des fetus. Munch Med Wochenschr 1906; 53: 811
9. Brown WH. A study of the esophageal lead in clinical electrocardiography. Part Ⅰ. The application if the esophageal lead to the human subject with observations on the Ta-wave, extrasystoles and bundle-branch block. Am Heart J, 1936; 12: 1-45
10. Brown WH. A study of the esophageal lead in clinical electrocardiography. Part Ⅱ. An electrocardiographic study of auricular disorders in the human subject by means of the esophageal lead. Am Heart J, 1936; 12: 307-38
11. Zoll PM. Resuscitation of the heart in ventricular standstill by external electrical stimulation. JAMA 1952; 247: 768
12. Burack B, Furman S. Transesophageal cardiac pacing Am J cardiol 1969; 23: 469
13. Montoyo JV, Angel J, Valle V, et, al Cardioversion of tachycardias by transesophageal atrial pacing Am J cardiol 1973; 32: 85
14．蒋文平，汪康平，等．经食管心房调搏结合固有心率测定评定窦房结功能．中华内科学杂志，1982，21：22
15. John J. Esophageal Pacing: A Diagnostic and Therapeutic Tool. Circulation, 1982; No2: 336-341
16．赵龙生，等．房室折返性心动过速逆行P波的心电图特征及其在旁道定位中的价值．中国心脏起博与心电生理杂志．1996；10(1)：28-29．
17．郑方胜，等．射频消融前经食管心房调搏检查对阵发性室上速的诊断价值．山东医药 2003；43(4)：15-17
18. Anderson HR, Pless P. Transesophageal pacing PACE 1983; 6: 674-679
19. Gallagher JJ, Smith WM, et,al. Esophageal pacing: A diagnostic and therapeutic tool Circulation 1982; 65: 336-341
20．周德麟 经食管心室起搏方法学研究初步报告 心电学杂志 1987；6(3)：157
21. Beson DW, Durmigan A, Benditt DG, et al. Transesophageal cardiac pacing history, application, technique. Clin Prog Pacing Electrophysiol, 1984; 2: 360-72
22. Shafiroff BGP, Linder J. Effects of external electrical pacemaker stimuli on the human heart. J Thorac Surg, 1957; 33: 544-50
23．沈剑清 新型食管心脏调搏电极导管的研制与应用 中国心脏起搏与心电生理杂志 1999；13(4)：201-204
24. David J. Cochrane. An esophageal and Gastric Approach to Ventricular Pacing. PACE, 1995(1); Part Ⅰ: 28-33
25. Pascal P, Mekeown J, et al. Transesophageal cardiaoversion. Am Heart J, 1993; 125: 399-403
26．朱德福．食管定向弯曲电极导管起搏、除颤及监护功能的实验研究．心脏起搏与电生理杂志 1994；8(3)：154-156
27．孙瑞龙，黄宛主编 心室性快速心律失常 临床心电图学 第五版 北京：人民卫生出版社 2001：371-396
28．李忠成 主编 室性心动过速 导管消融治疗学 第一版 天津：天津科学技术出版社 1995：212
29 Wiener I. Current applications of clinical electrophysiologic study in the diagnosis and treatment of cardiac arrhythmia. Am J Cardiol. 1989; 49(1): 1287
30. Waldo AL. Temporary cardiac pacing: Applications and techniques in the treatment of cardiac arrhythmias. Prog Cardiovas Dis. 1981; 23(6): 451
31. John D. Termination of ventricular tachycardia with bursts of rapid ventricular pacing. Am J Cardiol. 1978; 47(1): 94-101
32. Volkmann H. Termination of tachycardias by transesophageal electrical pacing. PACE 1992; 15(9); Part Ⅱ: 1962-66
33. Mceneaney D. A gastroesophageal electrode for electrophysiological studies. PACE; 1999; 22(3): 487-499
34．周德麟．经食管心室调搏终止顽固性阵发性室性心动过速．心电学杂志 1989；8(3)：138-140
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