Diagnosis of myocardial perforation by intracardiac electrograms recorded from the indwelling catheter

Durme, J. P. Van; Heyndrickx, Guy R.; Snoeck, J; Vermeire, P.; Pannier, R

doi:10.1016/s0022-0736(73)80002-0

Cited by 14 publications

(2 citation statements)

References 24 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 In four patients, the catheters were withdrawn under echocardiographic visualization and the catheter tips could be seen moving from the abnormal locations back into the right-heart chambers. Perforation was verified at autopsy in two patients, including one in whom the catheter was not withdrawn.Real-time, two-dimensional echocardiography appears to be valuable in the diagnosis of pacemaker perforation.INTRACARDIAC PACING is invaluable in the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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“…Perforation of the right ventricular free wall by stiff temporary pacing catheters is well known [31,32] but has not been reported with BMV procedures. Use of balloontipped pacing catheters can eliminate this problem.…”

Section: Precautions and Procedural Modificationsmentioning

confidence: 99%