Intracardiac electrocardiography during permanent pacemaker implantation: Predictors of cardiac perforation

Venkataraman, Kalyanasundaram; BILITCH, MICHAEL

doi:10.1016/0002-9149(79)90309-6

Cited by 6 publications

(2 citation statements)

References 23 publications

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“…Intracavitary elec- trographic studies have been reported to be fairly specific in the diagnosis of myocardial perforation, especially when performed during withdrawal of the pacing catheter.2?" 22,[35][36][37][38][39] M-mode and two-dimensional echocardiographic features of pacemaker electrodes in our laboratory have been described. ' (fig.…”

Section: Resultsmentioning

confidence: 99%

Real-time, two-dimensional echocardiographic features of pacemaker perforation.

Gondi¹,

Nanda²

1981

Circulation

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SUMMARY Five patients (four adults and one child) with clinically suspected myocardial perforation by temporary transvenous pacemakers were studied by real-time, two-dimensional echocardiography. In three patients, the catheters were visualized passing through the right ventricular apical wall with the tip located outside the cardiac border. In one patient the catheter perforated the atrioventricular septum and entered the left ventricle with the tip lodged against the posterior wall. In another patient, the catheter had partially penetrated the ventricular septum near the apex. Pericardial effusion was observed in two patients, in one of whom it was localized to the site of perforation. No patient had evidence of cardiac tamponade. In four patients, the catheters were withdrawn under echocardiographic visualization and the catheter tips could be seen moving from the abnormal locations back into the right-heart chambers. Perforation was verified at autopsy in two patients, including one in whom the catheter was not withdrawn.Real-time, two-dimensional echocardiography appears to be valuable in the diagnosis of pacemaker perforation.INTRACARDIAC PACING is invaluable in the management of patients with bradyarrhythmias and tachyarrhythmias, but may cause complications, including myocardial wall perforation, especially with temporary pacing catheters.'1-" Real-time, two-dimensional echocardiography is useful in the detection of myocardial wall perforation by temporary transvenous pacemakers. Materials and MethodsWe studied five patients in the Intensive Care Unit of Strong Memorial Hospital who developed problems with their temporary transvenous (arm vein) pacing catheters, such as loss of pacing, increased threshold or electrocardiographic evidence of catheter misplacement. These patients were part of an ongoing study in which 50 patients with right ventricular pacing catheters were evaluated by real-time, twodimensional echocardiography.Two-dimensional echocardiograms were performed using a commercially available, real-time, wide-angle (90°) mechanical sector scanner and a 3.0-MHz transducer (Advanced Technology Laboratories, Inc.). Images were recorded on videotapes for later analysis in real-time or slow motion. Polaroid photographs were made of stop-action frame images.Standard echocardiographic examinations were performed with the patient in the supine and left lateral decubitus positions.17' 18 Particular attention was given to the long-axis, apical and subcostal fourchamber planes. An the right atrium and right ventricle in long axis by rotating the transducer from the apical position. In all five patients the temporary pacing catheters were imaged as thick, dense, linear echoes in the rightsided chambers.'9 Catheter identification was supported by the presence of prominent posterior reverberatory echoes in four patients and a shadowing effect in the one patient.20 In all patients the catheter was followed distally to locate the tip. In three patients identification of the catheter tip was aided by the pre...

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Section: Resultsmentioning

confidence: 99%

Real-time, two-dimensional echocardiographic features of pacemaker perforation.

Gondi¹,

Nanda²

1981

Circulation

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“…Pacemaker Faiiure There were 3 (20%) instances of pacemaker failure in this series. However, the data from the manufacturer^ as of December 4, 1978 indicates that of the 726 pulse-generators involved in the advisory, 46 (6.3%) failures were seen. The malfunction was traced to a 10 kHz timing crystal which, in a small number of units, was subject to vacuum degradation resulting in sudden loss of pacemaker output.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience with a Programmable Pacemaker

Venkataraman

BILITCH

1980

Pacing Clinical Electrophis

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As part of a study to evaluate a new programmable pacemaker, 15 patients received lithium-powered R-wave inhibited, unipolar pulse-generators (CPI Model 0505). Five were initial implants (Group I) and 10 were pulse generator replacements (Group II). The follow-up period ranged from 1 to 18 months (mean 11 months). There were 5 deaths unrelated to the pacemaker. Three instances of pacemaker failure were identified and were characterized by a sudden loss of pacemaker output. THe malfunction, traced to a 10 kHz timing crystal, has been corrected in subsequently manufactured pulse-generators. In 11 patients, the pacemakers were programmed at a pulse width which was twice the threshold determined at 3 months. Four were programmed at 0.1 ms, three at 0.2 ms and four at 0.4 ms. Although no complications were seen in patients programmed at 0.1 ms pulse width, it might be advisable to leave pacemakers at 0.2 ms or greater for chronic pacing in patients with a pulse width threshold at 0.05 mg.

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