Echocardiographic evaluation of intracardiac pacing catheters: M-mode and two-dimensional studies.

Abstract

SUMMARY Thirty patients with right ventricular (RV) and 15 with coronary sinus (CS) pacing catheters were studied by M-mode echocardiography. RV catheters, detected in 23, appeared as linear echoes in the right ventricle during mitral valve recordings in 12, adjacent or superimposed on the tricuspid valve (TV) in 14, and immediately anterior to aortic root and pulmonary valve echoes in two with a redundant loop in RV outflow. In three with complete heart block, prominent systolic anterior movements of the TV occurred when atrial systole coincided with ventricular systole, probably due to catheter-induced TV "buckling" or exaggerated TV annular motion. Catheter echoes mimicked TV recordings in three, since its motion pattern was similar, although delayed and mimicked prolapsing right atrial myxomas in two because of multilayered com Seven of the patients (six adults, one child) with right ventricular and five with coronary sinus pacing catheters were examined by two-dimensional echocardiography using a commercially available Picker mechanical sector scanner. The transducer was placed in the left parasternal region and the long axis of the left and right ventricles were scanned. Next, the transducer was placed in the region of the left ventricular apex, and directed medially where a four chambered view (right atrium, right ventricle, left atrium, left ventricle) of the heart was obtained with visualization of the right ventricular apex. ResultsIntracardiac catheters were identified as thick linear complexes of intense echoes within right heart cavities. Frequent reverberations were recorded next to the main catheter echo ( fig. 1)

Coronary sinus pacer lead simulating left atrial mass.

“…1 -: 1 The lobing effect and reverberations from a dense echo-producing structure can mimic echoes of nonexistent structures. 2 In a patient with rheumatic mitml valve disease, the 1>resence of any echoes in the left atrium raises the suspicion of a thrombus.~. :; A thrombus was a consideration in our case.…”

Myocardial perforation due to temporary transvenous pacing catheters in pediatric patients

“…Pacing catheters within the cardiac chambers appear as thick, dense, closely packed linear echoes which can be differentiated from other intracavitary structures such as muscle bands or papillary muscles by the presence of reverberations or shadowing effect [ 12,141. The identification of the catheter tip may be aided by the visualization of two strong reverberations located 1 cm apart.…”

Cardiac catheterization under echocardiographic control in a pregnant woman

“…It is even possible that a strongly reflective object such as a catheter might be "falsely" imaged due to lateral resolution artifacts despite being entirely outside the plane of imaging [5]. Conversely, catheters may not always be detected [6]. Even in the nondilated aortic root in our patient, the catheter tip sometimes left the plane of imaging during manipulation.…”