Here we have to talk about a problem. There are many different ways to intervene in the same organ of the human body. The heart is a very special organ.
The heart is special in that its internal structure is responsible for the blood circulation center of the human body, and on the other hand, it needs the nutrition and support of the blood system. Therefore, its internal structure is connected to the body's large blood vessels to supply blood to the whole body, and the vascular system arranged outside its myocardium provides it with its own support.
Doctors plan various intervention pathways based on the anatomical characteristics of the heart (once again, everything in medicine is based on anatomy). The last interventional surgery to install a stent on this patient was to go to the coronary artery system on the surface of the heart, which is the relative "external" vascular pathway of the heart.
This interventional surgery to install a temporary pacemaker takes an "internal" approach to the heart, requiring the electrodes to be placed in the heart's internal structure.
Why are the two paths different?
It should be clear that the treatment path is aimed at the purpose of treatment.
The last time we went through the "external" vascular system was to solve the problem of the "external" vascular system being "blocked" last time.
The purpose of this discharge is to stimulate the myocardium. For this treatment purpose, there is no advantage in using an "external" system.
To use an analogy, walking through the "external" system is like walking through a complex alley (blood vessels) and knocking on the wall (stimulating the myocardium) across the alley wall (blood vessel wall), and the knocking points are obviously very restricted.
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In stark contrast, taking the "internal" route is like walking into a room (ventricle atrium) where the wall (myocardium) is located, and you can knock on all four sides. I, the doctor, can pick anywhere and choose the best place to knock on the wall.
At this point, you may ask, is it not possible to "knock on the wall" by taking the path outside the heart? Yes, surgical procedures place electrodes on the epicardium, which is to "knock on the wall" anywhere on the surface of the heart.
So does this mean that the intervention of installing a pacemaker is not an "external" approach at all? No.
Pacemakers are divided into single-chamber, dual-chamber, and triple-chamber pacemakers.
Single-chamber pacing has only one electrode, which is placed in the right atrium or right ventricle.
Why the right atrium or the right ventricle? Back to anatomy, the pacemaker is installed through the body veins, such as the subclavian vein. The body veins pass through the heart and are recycled from the superior and inferior vena cava to the right atrium of the heart.
For dual-chamber pacing, two electrodes are placed, one in the right atrium and one in the right ventricle.
When it comes to three-chamber pacing, don't forget that the left and right atria and ventricles are not connected. If you want to get another wire to the left side of the heart, you need to go through the "external" system, through the coronary sinus to the lateral wall of the left ventricle for stimulation.
The above can be simply understood as the patient's entire heart muscle may not be in good condition, and the doctor will try to stimulate the heart in multiple directions as much as possible in order to mobilize the entire heart to work.
The surgery for multiple discharge electrodes is the most complicated, so three-chamber pacing is usually used in permanent pacemaker surgery.
At present, this case is in the state of emergency treatment, and a temporary pacemaker operation 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 shed that can be used only for emergency purposes and then dismantled after the task is completed. It can also be a transitional measure, that is, a permanent pacemaker will be placed in the patient after it is withdrawn.
At this point, it is clear that the failure of this intervention probably has nothing to do with the "external" coronary system.
Receiving Ren Zhelun's gaze, the surgeon just now, Shen Youhuan, stepped forward to explain the situation: "It fell off."
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