Let’s talk about a problem here. There are many different ways to perform interventional surgeries on the same organ of the human body. The heart, in particular, is a very special organ.
What's special 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 connected internally to the body's large blood vessels to supply blood to the whole body, and outside its myocardium
The vascular system is arranged to give it its own support.
The doctor plans various intervention paths according to the needs according to 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 intervention path was to go to the coronary system on the surface of the heart, which was relatively small.
The "external" vascular pathways of the heart.
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 must be clear that the path of treatment is based on the purpose of treatment.
The last time I visited the "external" vascular system was to solve the "blocked" problem of the "external" vascular system.
The electrode discharge this time is to stimulate the myocardium. For this purpose of treatment, there is no advantage in using the "external" system.
For example, using the "external" system is equivalent to walking through a complicated alley (blood vessel) and knocking on the wall (stimulating the myocardium) across the alley (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, and you can knock on it from all sides. My doctor can pick anywhere and pick the best place to hit the wall.
Having said this, you may ask again, is it absolutely not allowed to take a path outside the heart to "knock on the wall"? Yes, surgical surgery is to place electrodes on the epicardium, which is exactly on the surface of the heart where you can pick and choose to "knock on the wall".
In this way, does the intervention of installing a pacemaker not take the "external" route at all? No.
Pacemakers are divided into single-chamber, double-chamber and triple-chamber pacing.
Single-chamber pacing has only one electrode, and the electrode is placed in the right atrium or right ventricle.
Why is it the right atrium or right ventricle? Going back to anatomy, the pacemaker is installed through the systemic veins, such as the subclavian vein, etc. The path from the systemic veins to the heart returns 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 atria 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, which goes through the coronary sinus to the left ventricular side wall for stimulation.
The above can be simply understood as the patient's entire heart myocardium may not be functioning properly, so doctors try to stimulate the heart in multiple directions in order to mobilize the entire heart to work.
The surgery with multi-point electrode discharge is the most complicated, so triple-chamber pacing is usually used in permanent pacemaker surgery.
This case is currently under rescue status, and what is being done is a temporary pacemaker surgery. From this, we can get a glimpse of the difference between a temporary pacemaker and a permanent pacemaker.
The 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, we can understand that the failure of this intervention probably has 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."
