Study Of The Pacemaker Wire And Lead By Real-time Three-dimensional Echocardiography

OBJECTIVE To Explore the feasibility and the application of the lead by the real-time three-dimensional echocardiography(RT-3DE) and contrast with the two-dimensional echocardiography,which can make a guidance for device implantation.METHOD The study subjects consists of 22 patients who do permanent cardiac pacemaker implantation from July 2007 to January 2009 in the First affiliated Hospital of Kunming Medical College.The pacemaker' leads was observated by RT-3DE after operation and was assessed their position,pathway,adjacent and the backstreaming of tricuspid valve.The we measure the preoperative and postoperative index with echocardiographic which include:left atrial diameter(LA),left ventricular end-diastolic diameter(LVDd),tricuspid regurgitation(TR),cardiac function index (left ventricular fraction shortening(FS),left ventricular ejection fraction(EF),and evaluate the effect of the treatment and prognosis of pacemakers.To discuss the imaging principle,the research advancement,the imaging characteristic of observation to the lead with RT-3DE,and contrast to the announcements and the local with wo-dimensional echocardiography,so make a better guidance to the method of operation.RESULTS The top lead can be observed by 2DE and RT-3DE,but the display of RT-3DE was higher than 2DE.RT-3DE can not only show the pathway of lead:the superior vena cava→right atrium→tricuspid valve→right ventricle,but also locate the specific location of the lead.We can found the tricuspid valve regurgitation by CDFI after operation,but it can not be displayed the cause of it.Through adjusting the images of RT-3DE and rotating the multi-angle obervations,it can shows the relation between the lead and tricuspid valve and we can determine the cause of tricuspid valve regurgitation.To compare a number of images,we can found the number of exact location cases pacemaker leads which were show by xiphoid four-chamber, right ventricular two-chamber,apical four-chamber,parasternal four-chamber were 19,15,14,3 respectively.According to the observation of the exact top lead position, the patients were divided into two groups:cardiac apex to free wall group and cardiac apex to ventricular septum group.To compare the indexs of cardiac structure and function,we can found the RA and TR of ventricular septum group were increased than preoperation,P＜0.05;FS,EF were decreased than preoperation,P＜0.01.The degree of regurgitation(mild,moderate,severe) than preoperation have no significant difference,P＞0.05.The LA,RA,LVDd,RV,TR of free wall group were increased than preoperation.FS,EF of free wall group were decreased than preoperation.The degree of regurgitation(mild,moderate,severe) than preoperation have no significant difference,P＞0.05.To compare to the two groups,we found that LVDd of ventricular septum group was decreased than free wall group,P＜0.05;FS of ventricular septum group was increased than free wall group,P＜0.01;TR of ventricular septum group was decreased than free wall group,P＜0.05.CONCLUSION the observation to the lead of pacemaker is feasible.The pathway,exact location,extent,adjacent,the relationship between the tricuspid valve and lead can been displayed clearly by RT-3DE.The best imaging of showing the lead is xiphoid four-chamber;the second is fight ventricular two-chamber;the third is apical four-chamber;the last is parasternal four-chamber.The lead location of cardiac apex to ventricular septum is better than the location of cardiac apex to free wall.