Pacemaker, ICD ve kardiyak cihazların normal konfigürasyonları

Özet

Acil toraks BT'sinde jeneratör ve kablolar sık karşılaşılan, fakat kalp odacıklarıyla ilişkisi bilinmediğinde yanlış komplikasyon yorumuna yol açabilen cihazlardır. BT; transvenöz, epikardiyal, terk edilmiş ve tamamen deri altı sistemlerin anatomik güzergâhını doğrudan gösterir. Kablonun kalbe girmeyen subkutan ICD yapısını veya koroner sinüs üzerinden geçen sol ventrikül elektrodunu tanımak malpozisyon sanısını önler. Beklenen elektrot pozisyonlarının bilinmesi, yanlış yorumlamayı önlemek için esastır.

Faz ve pencere

Kontrastsız tanısal

Jeneratör gövdesi ve elektrotlar toraks BT'de belirgin şekilde izlenir; BT, cihazın yerleşimi ve olası komplikasyonlar hakkında detaylı bilgi sağlar.

BT bulguları

• Jeneratörün pektoral subkutan veya subpektoral cepte, kablo giriş tarafına bağlı bulunması
• Sağ atriyum pacing elektrodu tipik olarak sağ atriyum apendiksine J biçimli bir kıvrımla uzanır; Bachmann demeti gibi farklı atriyal hedefler de kullanılabilir.
• Sağ ventrikül elektrodunun triküspit kapağı geçerek sağ ventrikül apeksinde veya septumunda sonlanması
• Resenkronizasyon sisteminde sol ventrikül elektrodu koroner sinüsten bir lateral veya posterolateral kardiyak vene ilerler ve epikardiyal yüzey boyunca seyreder.
• Jeneratör bağlantı noktasından başlayarak elektrotları kalp ucuna kadar dikkatle izle; bağlantı pinlerinin jeneratör konnektör bloğuna oturup oturmadığını değerlendir.
• Subkutan ICD elektrodunun sternum yanında deri altı planda ilerlemesi ve kalp boşluğuna girmemesi
• Epikardiyal elektrodun göğüs duvarından kalbin yüzeyine ulaşan cerrahi güzergâhı
• Transvenöz sağ ventrikül elektrodu triküspit kapağı geçer; koroner sinüs üzerinden ilerleyen sol ventrikül elektrodu ise triküspit kapağı geçmeden kardiyak ven içinde sonlanır.

Normalde

Doğal kalpte intrakardiyak metal yapı yoktur; cihazlı bireyde ise atriyal elektrot apendikste, ventriküler elektrot ventrikül apeksinde, CRT sisteminde ise sol ventrikül elektrodu koroner sinüs üzerinden posterolateral epikardiyal vine yerleşmiştir. Sternum önündeki subkutan ICD elektrodu miyokarda girmez ve transvenöz yoldan değil, parasternal deri altından yerleştirilir.

Ayırıcı tanı

Terk edilmiş elektrot

jeneratörle devamlı bağlantısı olmayan, ucu kapalı eski kablo parçası olarak seyreder.

Epikardiyal elektrot

intravasküler yoldan değil, kalp yüzeyine cerrahi erişim izinden ulaşır.

Subkutan ICD

sternum önünde yüzeyel seyreder ve kalp odacıklarına transvenöz giriş yapmaz.

Sol ventrikül pacing elektrodu

koroner sinüs yoluyla sol ventrikül posterolateral epikardiyal vine ulaşır; bu sey, sağ ventrikül kaçıran elektrotun malpoziyonu ile ayırt edilmelidir.

Tuzaklar

• Koroner sinüsteki sol ventrikül elektrodu posterior seyri nedeniyle ekstrakardiyak sanılabilir; koroner sinüs ostiumuna kadar geriye doğru izle.
• İnce kırık ve izolasyon arızalarını saptamak için elektrotlar jeneratör bağlantısından başlayarak ucuna kadar dikkatlice takip edilmelidir.
• Subkutan ICD'nin sternum önündeki kalın elektrodu sağ ventrikül kablosu değildir; miyokard veya büyük ven içine girmez.
• Sağ ventrikül elektrodu apeks dışında sağ ventrikül çıkış yolunda da sonlanabilir.

Kendini dene

1. Biventriküler pacing sisteminde koroner sinüs yoluyla sol ventrikül duvarındaki epikardiyal vene uzanan elektrot hangisidir?

   • Sol ventrikül koroner ven elektrodu
   • Sağ atriyum apendiks elektrodu
   • Sağ ventrikül apikal elektrodu
   • Sol parasternal subkutan ICD elektrodu
   Cevabı göster

   Sol ventrikül koroner ven elektrodu. Biventriküler sistemde sol ventrikül elektrodu koroner sinüs yoluyla sol ventrikül duvarındaki epikardiyal vene ilerler.

2. Sol parasternal deri altı planda uzanan, defibrilasyon için transvenöz elektrot gerektirmeyen elektrot hangi sisteme aittir?

   • Subkutan ICD kablosu
   • Santral ven kateteri
   • Sağ atriyal pacing elektrodu
   • Aort stent grefti
   Cevabı göster

   Subkutan ICD kablosu. S-ICD, defibrilasyon için transvenöz elektrot kullanmaz; algılama elektrotları ve şok bobinleri içeren elektrodu sol parasternal deri altı planda yer alır.

Bu konunun yer aldığı turlar

• Tüpler, kateterler ve cihazların BT'de değerlendirilmesi

İlgili konular

• Kalp pili/ICD elektrot malpozisyonu ve perforasyonu
• Kardiyak cihaz cebi enfeksiyonu ve elektrot ilişkili tromboz

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 16 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.