Temporary Cardiac Pacing

Wood, Mark A.; Ellenbogen, Kenneth A.

doi:10.1002/9780470750674.ch4

Cited by 8 publications

(11 citation statements)

References 79 publications

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“…Procedural complications associated with insertion of temporary pacing electrodes are well recognised and documented, as is subsequent loss of capture due to rising stimulation threshold or electrode displacement 1. Temporary transvenous pacing, if not applied correctly, may also directly provoke ventricular arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

Pacemaker induced ventricular fibrillation in coronary care units

McLeod

Jokhi

2004

BMJ

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Temporary transvenous pacing is an established treatment for many bradyarrhythmias associated with haemodynamic compromise in patients who have had acute myocardial infarction. Procedural complications associated with insertion of temporary pacing electrodes are well recognised and documented, as is subsequent loss of capture due to rising stimulation threshold or electrode displacement. 1 Temporary transvenous pacing, if not applied correctly, may also directly provoke ventricular arrhythmias. Here we report two cases of ventricular fibrillation that were caused by a temporary pacemaker in a coronary care unit. Case reports Case 1A 64 year old man was admitted to the coronary care unit with acute inferior myocardial infarction. He was noted to be hypotensive and have a nodal rhythm with no atrial activity at 30 beats/min. There was no response to atropine. A temporary pacing electrode was inserted and connected to an external ventricular demand pacemaker. During the following two days, at least 15 episodes of ventricular fibrillation and many sustained episodes of ventricular tachycardia occurred. Review of the electrocardiograms showed occasional failure of pacing and sensing and of pacing impulses delivered into the ST segment and the T wave of spontaneous beats causing ventricular fibrillation (fig 1). The pacemaker was turned off. A bradycardia with first degree atrioventricular block was noted, but the episodes of ventricular fibrillation stopped immediately and did not recur. Case 2A 73 year old man was admitted with breathlessness and lethargy. He had experienced pain typical of myocardial infarction two days previously. He was taking an angiotensin converting enzyme inhibitor, a calcium antagonist, and a blocker for hypertension. His pulse was 32 beats/min, and an electrocardiogram showed complete heart block with left bundle branch block. His blood pressure was 70/30 mm Hg even after intravenous fluid administration. A temporary pacing electrode was inserted and ventricular demand pacing started. Troponin T was 4.58 g/l (normal < 0.03 g/l); creatine kinase was 1025 units/l (normal < 190 units/l). There was evidence of undiagnosed diabetes and renal impairment (glucose 20.8 mmol/l; urea 16.5 mmol/l; creatinine 311 mol/l; HbA 1C 0.092%). An echocardiogram showed inferior wall akinesis, moderate mitral regurgitation, and raised right ventricular systolic pressure.He was treated with insulin, and blockade was stopped. Aspirin and simvastatin were also given.His condition improved, but four days after admission he suddenly developed ventricular fibrillation.Defibrillation was achieved with a 360 J shock, after two shocks at 200 J were ineffective. Episodes of ventricular tachycardia also occurred. He was given an intravenous loading dose of amiodarone followed by a continuous infusion.Three days later ventricular fibrillation recurred. Defibrillation with a single 200 J shock was successful. A magnesium infusion was started. Two further episodes occurred that night, each requiring defibrillation. Plans were ...

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Section: Introductionmentioning

confidence: 99%

Pacemaker induced ventricular fibrillation in coronary care units

McLeod

Jokhi

2004

BMJ

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“…Once inside the cardiac chambers, the pacing location can be assessed using the intracardiac electrograms (Figure 4.6). 13 The surface ECG can serve as a tool to assist in catheter tip localization (Table 4.3). Once the patient is stabilized, we recommend confirming the location of the catheter with fluoroscopy to minimize both the risk of dislodgement or perforation.…”

Section: Bipolar Electrodesmentioning

confidence: 99%

“…13 A common inferior venous approach toward placement of an endovascular temporary pacing catheter, most commonly from the right femoral vein.…”

mentioning

confidence: 99%

Temporary Cardiac Pacing

Bunch¹,

Osborn²,

Day³

2014

Cardiac Pacing and ICDs

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“…However, temporary pacemakers may be needed prior to surgery as risk of bradycardia with hemodynamic compromise is enhanced during anesthesia. There are several temporary pacing options such as transvenous, transesophageal, transcutaneous and transthoracic (external epicardial system) (3), but there are very few reports pertaining to older patients and one recent report in a neonate (2,4,5). Prophylactic pacing is indicated in cases with wide QRS complexes, history of Stokes–Adam syndrome, congestive heart failure, associated cardiac abnormalities and absence of chronotropic response to atropine.…”

mentioning

confidence: 99%

“…We, however, chose to have a transvenous pacemaker in place, before surgery for several reasons: it is impossible to predict the response of a child with CCHB during anesthesia as was seen in case of an asymptomatic infant with CCHB suffering from severe bradycardia needing external cardiac compressions (2). It was also felt that it might not be possible to institute temporary transvenous pacing in time, particularly in a crisis (3). The other reason was nonavailability of a transcutaneous pacing system for such a small infant.…”

mentioning

confidence: 99%