No abstract

A case is presented which describes the initiation of atrialventricular (A -VIntraoperative placement of temporary wires has been recommended during cardiac surgical cases. ''2 Routine placement of atrial, ventricular or both atrial and ventricular pacing leads is practiced by many surgeons during open-heart surgery. The following case report describes the use of an in situ bipolar transluminal ventricular pacing probe in conjunction with bipolar epicardial atrial wires to establish A-V sequential pacing in a patient with atrio-ventrieular heart block following cardiopulmonary bypass. Case reportThe patient was a 68-year-old, 80 kg female with triple vessel coronary artery disease and progressive angina, scheduled for elective coronary artery bypass surgery. The patient had a Medtronic model #7005 A-V sequential pacemaker placed two months prior to admission, for high grade A-V block. It was decided that pulmonary artery pressure monitonng would be beneficial so a Paceport* (American Edwards) pulmonary artery cathether was placed in the right internal jugular vein to allow for emergency ventdcular pacing, if it became necessary. The Paceport* pulmonary artery catheter has a modified right ventricular port which accepts a separately packaged Chandler | (American Edwards) transluminal ventricular pacing wire. The case proceeded uneventfully until shortly before atrial cannolation when use of the electrocautery converted the permanent pacemaker function from an A-V sequential rate of 75 9 min -~ to ventricular pacing (VVI) at a rate of 60 9 min -1 . The haemodynamic response was a decrease in blood pressure from 116/ 70mmHg to 90/55 mmHg and a decrease in cardiac output (CO) frem 4.2 to 2.8 L-min -I. Temporary transvenous pacing to a rate of 80 9 min-1 was instituted using the ventrieular pacing probe thereby improving blood pressure to 98/58 mmHg and CO to 3.2 L" rain-'. Temporary pacing was discontinued during cardiopulmonary bypass (CPB) while four distal anastamoses and three proximal anastamoses were completed. Reprograming capability for the permanent pacemaker was not available. Immediately prior to weaning from CPB, the patient was in sinus rhythm at a rate of 67 beats, min-i. Bipolar atrial CAN I ANAESTH 1988 / 35:3 / pp309-1t