Let’s talk about a problem here. There are various ways of interventional surgery to deal with the same organ in the human body. The organ in particular, the heart, is very special.
The special thing about the heart is that its internal structure is responsible for the blood circulation center of the human body. On the other hand, it itself needs nutrition and support from the blood system. Therefore, its structure is internally connected to the body's major blood vessels to supply blood to the whole body, and the vascular system arranged outside its myocardium gives it its own support.
Doctors plan various intervention paths according to the needs based on the anatomical characteristics of the heart (again, the anatomy of everything in medicine is the basis). The last interventional surgery was to install a stent on this patient. The interventional path was to go to the coronary system on the surface of the heart, and the corresponding "external" blood vessel path was taken.
This interventional surgery to install a temporary pacemaker takes an "internal" route to the heart, going to the internal structure of the heart to place electrodes.
Why are the two paths different?
It should be clear that the path of treatment is the purpose of treatment.
The last trip to the "external" vascular system was to solve the problem of "blockage" in the "external" vascular system last time.
This time the electrode is discharged to stimulate the myocardium. For this therapeutic purpose, there is no advantage in using the "external" system.
For example, using the "external" system is equivalent to walking through a complicated alleyway (blood vessel) and knocking on the wall (stimulating the myocardium) across the alleyway (blood vessel wall). It is obviously very restrictive to hit the point.
In sharp contrast, taking the "internal" path is like walking to the room (ventricle and atrium) where the wall (myocardium) is, knocking on all sides. My doctor can pick anywhere and pick the best place to build a wall.
Having said this, you may ask again, is it definitely not allowed to take the path outside the heart and "knock on the wall"? Yes, by surgically placing electrodes on the epicardium, you are freeing your hands and feet to pick and "knock on the wall" on the surface of the heart.
In this way, does the intervention of installing a pacemaker not take the "external" route at all? Neither.
Pacemakers are divided into single-chamber, double-chamber and triple-chamber pacing.
Single-chamber pacing has only one electrode, which is placed in the right atrium or right ventricle.
Why right atrium or right ventricle? Returning to anatomy, the pacemaker is installed through systemic veins, such as the subclavian vein, etc. The path from the systemic veins to the heart returns from the inferior vena cava to the right atrium of the heart.
For dual-chamber pacing, two electrodes are placed, one in the right atrium and the other in the right ventricle.
When it comes to three-chamber pacing, don’t forget that the left and right atriums and ventricles are not connected. If you want to use another wire to go to the left side of the heart, you need to go through the "external" system, and go through the coronary sinus to the left ventricular lateral wall for stimulation.
The above can be simply understood to mean that the patient's entire heart myocardium may not be functioning properly. In order to mobilize the entire heart to work, the doctor should try to stimulate the heart in multiple directions as much as possible.
The surgery with multi-point electrode placement is the most complicated, so triple-chamber pacing is usually used in permanent pacemaker surgery.
This case is currently under rescue status and a temporary pacemaker surgery is required. From this we can get a glimpse of the difference between a temporary pacemaker and a permanent pacemaker.
A temporary pacemaker can be simply understood as a temporary shelter, which can be used only for temporary emergency use and then removed after completing the task, or it can be a transitional measure, that is, a permanent pacemaker must be placed in the patient after withdrawal.
Having said this, it can be understood that the failure of this intervention may have nothing to do with the "external" coronary system.
After receiving Ren Zhelun's look, Shin Youhwan, the surgeon just now, came up and explained the situation: "It fell off."
(End of chapter)
