The Journal of Thoracic and Cardiovascular Surgery, Vol 71, 493-501, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Special pacemaker catheter techniques. The transmediastinal placement of sensing electrodes
M Kleinert, P Beer and J Nahrstedt
The clinical utilization of atrial programmed pacemakers is limited by the
lead systems available for sensing of atrial activity. The endocardial
method of lead placement is burdened by a dislodgement rate of up to 30 per
cent. Alternatively, the patient must submit to the risks of a thoracotomy.
Thirty-one patients have been treated with a transmediastinally,
retrocardially positioned atrial detector electrode. In 20 patients (65 per
cent) the detector performed as desired with no postimplant revision. In 11
patients (35 per cent) corrective measures were required primarily to
correct lead placement; seven of these were corrected under local
anesthesia merely by pulling the catheter. Spontaneous lead dislocation
occurred in four patients. Four patients (13 per cent) underwent
remediastinoscopy due to cranial displacement of the detector electrode
with a resulting decrease in atrial potential to less than 0.5 mV. For
technical reasons, the lead placements were performed without the benefit
of x-ray illumination, with only an ECG check of the posterior atrial wall,
and this may account for the relatively high incidence of revision.
Transmediastinal placement of sensing electrodes presents a practicable
alternative to methods presently used.
