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目的 建立心腔内超声和组织多普勒显像技术引导监控下的希氏束起搏和房室结消融方法。方法 6只犬急性闭胸模型。经颈静脉插入超声导管确定希氏束和房室结准确空间位置、超声解剖结构标志及其内心肌激动顺序。引导心脏起搏或消融导管到达靶组织 ,监控刺激电极植入过程和确认消融电极与心内膜面接触。分别释放电脉冲进行靶点起搏和射频消融 ,同步体表心电图QRS波形态确认实现希氏束起搏和Ⅲ度房室传导阻滞。结果 实现了直接希氏束起搏 (1例 )和希氏束加室间隔起搏 (5例 )。希氏束起搏阈值为 :电压 (3 .0± 1 .0 )V ,脉宽 0 .5ms。希氏束起搏时导致了较早的室间隔电兴奋。窦性心律和希氏束起搏时QRS波宽度分别为 (59.7± 5 .3)ms和 (82 .8± 1 6 .6)ms (P =0 .0 2 )。完成希氏束起搏和房室结消融的平均操作时间分别为 40min(3～ 81min)和 3min(2～ 5min) ;平均X线曝光时间为 1 3min(1～ 55min)。病理解剖和组织切片表明希氏束起搏和房室结消融定位准确、效果肯定。结论 心腔内超声技术能够准确引导心脏介入导管实现希氏束起搏和房室结消融 ,减少导管操作和X线曝光时间
Objective To establish the method of intracardiac echocardiography and tissue Doppler imaging to guide the monitoring of His bundle pacing and atrioventricular node ablation. Methods Six dogs with acute chest closure model. Ultrasound catheter was inserted through the jugular vein to determine the exact spatial location of His bundle and atrioventricular node, the ultrasonic anatomic structure and the order of cardiac muscle activation. The cardiac pacing or ablation catheter is directed to reach the target tissue, the stimulation electrode implant is monitored and the ablation electrode is placed in contact with the endocardial surface. Respectively, the release of electrical pulses for target pacing and radiofrequency ablation, synchronized surface ECG QRS waveform confirmation of His bundle pacing and Ⅲ degree atrioventricular block. Results Direct His bundle pacing (1 case) and His bundle interventricular septal pacing (5 cases) were achieved. His bundle pacing threshold: voltage (3 .0 ± 1 .0) V, pulse width 0.5ms. His bundle pacing led to earlier ventricular septate excitement. The sinus rhythm and His bundle pacing QRS wave width were (59.7 ± 5.3 ms) and (82.8 ± 1.6 6) ms (P = 0. 02). The mean time to complete His bundle pacing and atrioventricular node ablation were 40 min (3 to 81 min) and 3 min (2 to 5 min), respectively. The mean X-ray exposure time was 13 min (1 to 55 min). Pathological anatomy and tissue sections showed that His bundle pacing and atrioventricular node ablation accurate positioning, the effect is affirmed. Conclusion Intracardiac echocardiography can accurately guide the cardiac catheterization to achieve His bundle pacing and atrioventricular node ablation, reduce the catheter operation and X-ray exposure time