Intisar Ahmed MBBS, FCPS , Chloe Netlefold MBBS, FRACP , Robert D. Anderson MBBS, PhD, Stephane Masse MASc, Melanie R. Burg MD, MSc, Tirone E. David MD, FRCSC, Jane Heggie MD, FRCP, Maral Ouzounian MD, PhD, Kumaraswamy Nanthakumar MD, FRCPC
{"title":"术后临时心外膜起搏:当代起搏导联设计的电生理意义","authors":"Intisar Ahmed MBBS, FCPS , Chloe Netlefold MBBS, FRACP , Robert D. Anderson MBBS, PhD, Stephane Masse MASc, Melanie R. Burg MD, MSc, Tirone E. David MD, FRCSC, Jane Heggie MD, FRCP, Maral Ouzounian MD, PhD, Kumaraswamy Nanthakumar MD, FRCPC","doi":"10.1016/j.cjco.2025.06.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in postoperative temporary epicardial pacing leads, sensing malfunction can still happen. Oversensing presents as inappropriate inhibition of pacing (a major concern for pacemaker-dependent patients), whereas undersensing may lead to an extremely rare complication of ventricular fibrillation from R on T. The single-lead and dual-lead configurations have key structural differences related to the size of the bipole electrodes and the spacing between them. We assessed how this affects the sensing function.</div></div><div><h3>Methods</h3><div>Five porcine studies were conducted using open chest and Langendorff models. We used 2 pacing wire configurations and compared the sensed electrograms. We compared a newer single-lead configuration (small, closely spaced electrodes) with a dual-lead (large, widely spaced) configuration. The primary outcome was the amplitude of the R wave. Secondary outcomes were the relative size of the T wave and the effect of sampling frequency and low-pass filtering.</div></div><div><h3>Results</h3><div>The sensed QRS was significantly larger in the widely spaced, larger electrodes when compared with closely spaced, smaller electrodes across all sampling frequencies and filter settings (6.9-29.7 mV vs 1.7-8.6 mV, <em>P</em> < 0.001). The average amplitude of the T wave was closer to the average QRS amplitude with the newer configuration across all settings. The mean T wave to R wave difference ranged from 3.0 to 3.7 mV for the single lead and 1.0 to 21.5 mV for the dual lead configuration. Large, widely spaced electrodes resulted in much larger sensed QRS signals and a safer programming window for sensitivity.</div></div><div><h3>Conclusions</h3><div>The smaller, closely spaced electrodes detect a relatively small QRS and a larger T wave, leading to a narrower safety window and an increased risk of sensing malfunction (Central Illustration). To avert catastrophic consequences, the electrophysiologic implications of new temporary pacing wires must be considered during postoperative care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1162-1169"},"PeriodicalIF":2.5000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postsurgical Temporary Epicardial Pacing: Electrophysiological Implications of Contemporary Pacing Lead Designs\",\"authors\":\"Intisar Ahmed MBBS, FCPS , Chloe Netlefold MBBS, FRACP , Robert D. Anderson MBBS, PhD, Stephane Masse MASc, Melanie R. Burg MD, MSc, Tirone E. David MD, FRCSC, Jane Heggie MD, FRCP, Maral Ouzounian MD, PhD, Kumaraswamy Nanthakumar MD, FRCPC\",\"doi\":\"10.1016/j.cjco.2025.06.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Despite advancements in postoperative temporary epicardial pacing leads, sensing malfunction can still happen. Oversensing presents as inappropriate inhibition of pacing (a major concern for pacemaker-dependent patients), whereas undersensing may lead to an extremely rare complication of ventricular fibrillation from R on T. The single-lead and dual-lead configurations have key structural differences related to the size of the bipole electrodes and the spacing between them. We assessed how this affects the sensing function.</div></div><div><h3>Methods</h3><div>Five porcine studies were conducted using open chest and Langendorff models. We used 2 pacing wire configurations and compared the sensed electrograms. We compared a newer single-lead configuration (small, closely spaced electrodes) with a dual-lead (large, widely spaced) configuration. The primary outcome was the amplitude of the R wave. Secondary outcomes were the relative size of the T wave and the effect of sampling frequency and low-pass filtering.</div></div><div><h3>Results</h3><div>The sensed QRS was significantly larger in the widely spaced, larger electrodes when compared with closely spaced, smaller electrodes across all sampling frequencies and filter settings (6.9-29.7 mV vs 1.7-8.6 mV, <em>P</em> < 0.001). The average amplitude of the T wave was closer to the average QRS amplitude with the newer configuration across all settings. The mean T wave to R wave difference ranged from 3.0 to 3.7 mV for the single lead and 1.0 to 21.5 mV for the dual lead configuration. Large, widely spaced electrodes resulted in much larger sensed QRS signals and a safer programming window for sensitivity.</div></div><div><h3>Conclusions</h3><div>The smaller, closely spaced electrodes detect a relatively small QRS and a larger T wave, leading to a narrower safety window and an increased risk of sensing malfunction (Central Illustration). To avert catastrophic consequences, the electrophysiologic implications of new temporary pacing wires must be considered during postoperative care.</div></div>\",\"PeriodicalId\":36924,\"journal\":{\"name\":\"CJC Open\",\"volume\":\"7 9\",\"pages\":\"Pages 1162-1169\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CJC Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589790X25004007\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X25004007","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:尽管术后临时心外膜起搏导线取得了进展,但仍可能发生感应功能障碍。过度敏感表现为对起搏的不适当抑制(这是起搏器依赖患者的一个主要问题),而感知不足可能导致从R到t的心室颤动的极其罕见的并发症。单导联和双导联配置具有关键的结构差异,与双极电极的大小和它们之间的间距有关。我们评估了这对感知功能的影响。方法采用开胸和Langendorff模型对5只猪进行研究。我们采用两种起搏导线配置,并比较感应电图。我们比较了一种新的单引线结构(小的,紧密间隔的电极)和双引线结构(大的,广泛间隔的)。主要结果是R波的振幅。次要结果是T波的相对大小以及采样频率和低通滤波的影响。结果在所有采样频率和滤波器设置下(6.9-29.7 mV vs 1.7-8.6 mV, P < 0.001),宽间距、大间距电极的感应QRS明显大于窄间距、小间距电极。在所有设置中,在较新的配置下,T波的平均振幅更接近平均QRS振幅。单引线的平均T波和R波差为3.0 ~ 3.7 mV,双引线配置的平均T波和R波差为1.0 ~ 21.5 mV。大而宽间距的电极产生了更大的感应QRS信号和更安全的灵敏度编程窗口。更小、间距更近的电极检测到相对较小的QRS和更大的T波,导致更窄的安全窗口和更大的传感故障风险(中央插图)。为了避免灾难性的后果,在术后护理中必须考虑到新的临时起搏导线的电生理影响。
Postsurgical Temporary Epicardial Pacing: Electrophysiological Implications of Contemporary Pacing Lead Designs
Background
Despite advancements in postoperative temporary epicardial pacing leads, sensing malfunction can still happen. Oversensing presents as inappropriate inhibition of pacing (a major concern for pacemaker-dependent patients), whereas undersensing may lead to an extremely rare complication of ventricular fibrillation from R on T. The single-lead and dual-lead configurations have key structural differences related to the size of the bipole electrodes and the spacing between them. We assessed how this affects the sensing function.
Methods
Five porcine studies were conducted using open chest and Langendorff models. We used 2 pacing wire configurations and compared the sensed electrograms. We compared a newer single-lead configuration (small, closely spaced electrodes) with a dual-lead (large, widely spaced) configuration. The primary outcome was the amplitude of the R wave. Secondary outcomes were the relative size of the T wave and the effect of sampling frequency and low-pass filtering.
Results
The sensed QRS was significantly larger in the widely spaced, larger electrodes when compared with closely spaced, smaller electrodes across all sampling frequencies and filter settings (6.9-29.7 mV vs 1.7-8.6 mV, P < 0.001). The average amplitude of the T wave was closer to the average QRS amplitude with the newer configuration across all settings. The mean T wave to R wave difference ranged from 3.0 to 3.7 mV for the single lead and 1.0 to 21.5 mV for the dual lead configuration. Large, widely spaced electrodes resulted in much larger sensed QRS signals and a safer programming window for sensitivity.
Conclusions
The smaller, closely spaced electrodes detect a relatively small QRS and a larger T wave, leading to a narrower safety window and an increased risk of sensing malfunction (Central Illustration). To avert catastrophic consequences, the electrophysiologic implications of new temporary pacing wires must be considered during postoperative care.