Thomas Wild, Nermin Serbecic, Sven Christoph Beutelspacher, Meinhard Ploner, Zeno Deckert, Rainald Seitelberger
{"title":"Transmyocardial laser revascularization: epicardial ECG detection provides efficient R-wave triggering during mobilization of the heart.","authors":"Thomas Wild, Nermin Serbecic, Sven Christoph Beutelspacher, Meinhard Ploner, Zeno Deckert, Rainald Seitelberger","doi":"10.1089/104454703321895590","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>In order to achieve an accurate intraoperative ECG detection, a new technique in detecting the trigger-signal was developed. In contrast to the traditional three-lead ECG-configuration, the left leg electrode was connected to a transient epicardial pacemaker electrode on the left-ventricular surface.</p><p><strong>Background data: </strong>The Holmium:YAG-Laser for Transmyocardial Laser Revascularization (TMLR) is R-wave-triggered, providing the release of energy only during the refractory period of the heart cycle. However, an exact ECG-triggering during mobilization of the apex and/or posterior wall is difficult to achieve by using conventional ECG-configuration, therefore increasing the risk for mistriggering and induction of arrhythmias during TMLR.</p><p><strong>Materials and methods: </strong>Two groups of patients, all undergoing stand alone TMLR-procedures via left minithoracotomy, were compared. Ten patients were operated with the conventional ECG configuration (group 1) and ten patients with the modified epicardial ECG configuration (group 2).</p><p><strong>Results: </strong>In patients of group 1, as a result of a loss of the trigger signal or due to the triggering of artifacts, the incidence of correctly triggered QRS-complexes was 56% of all documented QRS-complexes. In contrast, an excellent triggering was observed in 98% (p < 0.001) in group 2, resulting in a reduction of laser operative time by 35% (p < 0.001) and a decrease in the incidence of intraoperative ventricular fibrillation (0 vs. 3).</p><p><strong>Conclusion: </strong>In conclusion, this new ECG configuration is a simple but effective method in achieving an excellent ECG signal during all stages of TMLR. As a consequence, a reduction in operative time and incidence of ventricular fibrillation can be achieved.</p>","PeriodicalId":79503,"journal":{"name":"Journal of clinical laser medicine & surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/104454703321895590","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical laser medicine & surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1089/104454703321895590","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
Abstract
Objective: In order to achieve an accurate intraoperative ECG detection, a new technique in detecting the trigger-signal was developed. In contrast to the traditional three-lead ECG-configuration, the left leg electrode was connected to a transient epicardial pacemaker electrode on the left-ventricular surface.
Background data: The Holmium:YAG-Laser for Transmyocardial Laser Revascularization (TMLR) is R-wave-triggered, providing the release of energy only during the refractory period of the heart cycle. However, an exact ECG-triggering during mobilization of the apex and/or posterior wall is difficult to achieve by using conventional ECG-configuration, therefore increasing the risk for mistriggering and induction of arrhythmias during TMLR.
Materials and methods: Two groups of patients, all undergoing stand alone TMLR-procedures via left minithoracotomy, were compared. Ten patients were operated with the conventional ECG configuration (group 1) and ten patients with the modified epicardial ECG configuration (group 2).
Results: In patients of group 1, as a result of a loss of the trigger signal or due to the triggering of artifacts, the incidence of correctly triggered QRS-complexes was 56% of all documented QRS-complexes. In contrast, an excellent triggering was observed in 98% (p < 0.001) in group 2, resulting in a reduction of laser operative time by 35% (p < 0.001) and a decrease in the incidence of intraoperative ventricular fibrillation (0 vs. 3).
Conclusion: In conclusion, this new ECG configuration is a simple but effective method in achieving an excellent ECG signal during all stages of TMLR. As a consequence, a reduction in operative time and incidence of ventricular fibrillation can be achieved.