Pacing electrode

Littleford PO, Spector SD (1979) Device for the rapid insertion of a permanent endocardial pacing electrode through the subclavian vein preliminary report. Ann Thorac Surg 27(3) 265-269... 

Pauletti M, Pingitore R, Contini C (1979) Superior vena cava stenosis at site of intersection of two pacing electrodes. Br Heart J 42(4) 487 89... 

Walters MI, Kaye GC (1999) Pulmonary embolization of a pacing electrode fragment complicating lead extraction. Pacing Clin Electrophysiol 22(5) 823-824... 

Although dexamethasone sodium phosphate has been the most widely used glucocorficosteroid in steroid-eluting pacing electrodes, more recently dexamethasone acetate, originally proposed in 1991 (39), has also been... 

Mugica J. Progress and development of cardiac pacing electrodes (Part I). PACE 1990 13 1558. 

Fig. 4.42 From left to right the first electrode is an endocardial rate sensing and pacing electrode. Endocardial high-energy spring electrode in the middle pair. Epicardial patches and pair on the extreme left epicardial rate sensing electrodes. (Courtesy of Guidant, Inc., St. Paul, MN.)...

In a similar approach, pacemaker leads have been placed via transhepatic cannulation (Fig. 4.64) (118). Venous access is achieved percutaneously with the guidewire passed transhepaticaUy, the sheath set is applied, allowing the subsequent introduction of a permanent pacing electrode. Once again, this procedure has been reserved for complex congenital anomahes that preclnde venous access via a superior vein. 

The introduction and manipulation of pacing leads are frequently associated with both tachyarrhythmias and bradyarrhythmias as a lead negotiates the chambers of the right heart. Ventricular tachycardia is extremely common as the pacing electrode or guidewire contacts the right ventricular myocardium. Simple withdrawal of these objects usually terminates the arrhythmia. In extreme cases, sustained monomorphic ventricular tachycardia and even ventricular fibrillation may occur. Some institutions have instituted a policy of placing external defibrillation pads prophylactically in anticipation of required cardioversion. 

Nash A, Burrell CJ, Ring NJ, et al. Evaluation of an ultrasonically guided venipuncture technique for the placement of permanent pacing electrodes. PACE 1998 21 452. 

Bognolo DA, Vijayanagar RR, Eckstein PF, et al. Method for reintroduction of permanent endocardial pacing electrodes. PACE 1982 5 546. 

Fig. 6.42 Permanent active-fixation pacing electrode placed via the right internal jugular vein. Suture sleeve securing the lead to the neck. Lead connected to the explanted pulse generator, which is sutured to the anterior chest.

Sulke N, Chambers J, Blauth C. Life-threatening degeneration of the Accufix active fixation atrial pacing electrode. Lancet 1995 346 25. 

Fig. 7.1 Correct position of transcutaneous pacing electrodes. Top Anteroposterior positioning with the cathode (circle) over the cardiac apex and the anode (rectangle) in the back between the spine and the right scapula (the space between the spine and left scapula can also be used). Bottom Anterior-anterior position with the cathode over the cardiac apex and the anode on the right chest.

Fig. 7.7 (A) Twelve-lead ECG during pacing demonstrates left bundle-branch block morphology and inferiorly directed mean frontal plane axis, suggesting that the pacing electrode is in the right ventricular outflow tract. (B) Pacing lead placement in the right ventricular apex is indicated by the left bundle branch block morphology and the mean frontal plane superior axis. Notice that the pacemaker does not sense the premature ventricular depolarization (fourth QRS complex in all leads), which indicates that the sensitivity should be increased (by reducing the sensitivity value).

Cutler NG, Karpawich PP, Cavitt D, Hakimi M, Walters HL. Steroid-eluting epi-cardial pacing electrodes six year experience of pacing thresholds in a growing pediatric population. Pacing Chn Electrophysiol 1997 20 2943-8. 

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