Screw electrode

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Today's screw electrodes are located at the distal end of an electrode , on the electrode head, and form an important component of the pacemaker system . Its function is to actively fix the probe tip in the heart with a corkscrew-like screw device.

Types

Screw that can be screwed in and out

Screw electrode (bisping type)

The screw electrode system includes various designs. One of the screwing systems, also known in English-speaking countries as the "bisping electrode", has a screw that can be screwed in and out. This enables a transvenous, atraumatic introduction of the probe and positioning of the electrode at a suitable location in the heart without having to pay attention to an exposed screw tip. As soon as the ideal stimulation location has been determined, the screw can be unscrewed and the electrode can be fixed endocardially in the heart . It is also true that this mechanism enables easier explantation.

Rigid screw

Another type of screw electrode model is equipped with a rigid screw. Since this does not require a rotating mechanism, its construction and the chosen delivery system are thinner. However, due to the exposed screw, this type of electrode should be turned counterclockwise during insertion, otherwise the probe could get caught in vessels or on the tricuspid valve .

History / development history

The most common screw electrode was developed and patented by Hans-Jürgen Bisping in 1977. This probe with a screw that can be screwed in and out ("bisping electrode") offered an alternative to the rigid screw models prevailing on the market at the time. In the ten years after the market launch of the electrode with screw-in and screw-out screw (Bisping type), this screw technology developed further and is still a very popular model for active fixation methods. All manufacturers in this field now offer a comparable version of this screwdriving system.  

Differentiation from other electrode types

In general, it can be said that the implantation of a screw electrode results in an advantageously low dislocation rate. On the other hand, the active anchoring of the screw tip leads to an injury to the corresponding tissue, which leads to an inflammatory reaction and an increase in the stimulation threshold. However, this stimulation threshold is only acutely higher after fixation in comparison to an anchor electrode and adjusts to its level in the further course through the use of a screw-type probe containing cortisone. During the implantation, the screw electrode enables the free choice of the location, which can thus be selected according to the best possible functionality of the pacemaker . Screw electrodes can therefore be placed in the right ventricle as well as in the right atrium , as they do not require any special anatomical structures (myocardial trabecula) like the passively fixed anchor electrodes . Active fixation is mainly used on the smoother surface of the right atrium.

Individual evidence

  1. ↑ Borst, HG, W. Klinner and H. Oelert (1991): Heart surgery - The interventions on the heart and on the vessels near the heart, Springer Verlag: Berlin Heidelberg 1991, 2nd edition, pp. 489-490.
  2. ↑ Lüderitz, B. (1986): Pacemaker - Therapy and Diagnosis of Cardiac Arrhythmias. Springer-Verlag: Berlin Heidelberg 1986, p. 413.
  3. ↑ Hombach, V. (2001): Interventional Cardiology, Angiology and Cardiovascular Surgery: Technology, Clinic, Therapy. Schattauer Verlag: Stuttgart 2001, p. 170.
  4. ^ Sigg, DC, PA Iaizzo, Y.-F. Xiao and B. He (2010): Cardiac Electrophysiology Methods and Models. Springer Science & Business Media: LLC 2010, p. 14.
  5. ^ Elbow, KA and MA Wood: Cardiac Pacing and ICDs. Blackwell Publishing: 2008, 5th ed., 568 pages.
  6. ^ Yoo, H.-J. and C. van Hoof (2011): Bio-Medical CMOS ICs. Springer Science & Business Media: LLC 2011, pp. 96-97.
  7. ↑ Hombach, V. (2001): Interventional Cardiology, Angiology and Cardiovascular Surgery: Technology, Clinic, Therapy. Schattauer Verlag: Stuttgart 2001, p. 170.
  8. ^ Elbow, KA and MA Wood: Cardiac Pacing and ICDs. Blackwell Publishing: 2008, 5th ed., 568 pages.
  9. ^ Sigg, DC, PA Iaizzo, Y.-F. Xiao and B. He (2010): Cardiac Electrophysiology Methods and Models. Springer Science & Business Media: LLC 2010, p. 14.
  10. ^ Yoo, H.-J. and C. van Hoof (2011): Bio-Medical CMOS ICs. Springer Science & Business Media: LLC 2011, pp. 96-97.
  11. ^ Bisping, H.-J. and H. Rupp (1977): A new permanent transvenous electrode for fixation in the atrium. In Proceedings of the Vth International symposium on cardiac pacing, Excerpta Medica, Amsterdam, pp. 543-547.
  12. ^ Bisping, H.-J., J. Kreuzer and H. Birkenheier (1980): Three-Year Clinical Experience with a New Endocardial Screw-In Lead with Introduction Protection for Use in the Atrium and Ventricle. In Pacing and Clinical Electrophysiology, 3 (4), pp. 424-435.
  13. ↑ Stenzl, W., KHTscheliessnigg, D. Dacar, W. Hermann and F. Iberians (1983): Four years experience with the Bisping transvenous pacemaker electrode. In Cardiac Pacing, Dr. Dietrich Steinkopff Publisher: Darmstadt 1983, pp. 427-431.
  14. ^ Electrode for implantation in the heart US 4282885 A. Retrieved May 20, 2016 .
  15. ↑ Implantable lead assembly with extendable screw-in electrode US 4886074 A. Retrieved May 20, 2016 .
  16. ^ Sigg, DC, PA Iaizzo, Y.-F. Xiao and B. He (2010): Cardiac Electrophysiology Methods and Models. Springer Science & Business Media: LLC 2010, p. 14.
  17. ↑ Fröhlig, G., J. Carlsson, J. Jung, W. Koglek and B. Lemke (2013): Pacemaker and Defibrillator Therapy - Indication - Programming - Follow-up Care. Georg Thieme Verlag: Stuttgart 2013, 2nd ed., Pp. 256–294.
  18. ↑ Hombach, V. (2001): Interventional Cardiology, Angiology and Cardiovascular Surgery: Technology, Clinic, Therapy. Schattauer Verlag: Stuttgart 2001, p. 170.
  19. ↑ Fröhlig, G., J. Carlsson, J. Jung, W. Koglek and B. Lemke (2013): Pacemaker and Defibrillator Therapy - Indication - Programming - Follow-up Care. Georg Thieme Verlag: Stuttgart 2013, 2nd ed., Pp. 256–294.
  20. ^ Elbow, KA and MA Wood: Cardiac Pacing and ICDs. Blackwell Publishing: 2008, 5th ed., 568 pages.
  21. ↑ Morschhäuser, D. and W. Fischer (2013): Practice of pacemaker follow-up care - basics, functions, control, optimization, troubleshooting. Springer-Verlag: Berlin Heidelberg 2013, 2nd edition, pp. 4-6.
  22. ↑ Hombach, V. (2001): Interventional Cardiology, Angiology and Cardiovascular Surgery: Technology, Clinic, Therapy. Schattauer Verlag: Stuttgart 2001, p. 170.
  23. ↑ Kramme, R. (2011): Medical technology - procedures - systems - information processing. Springer Science & Business Media: Berlin Heidelberg 2011, 4th edition, pp. 631–633.