Life-threatening Ventricular Dysrhythmias with Inadvertent Asynchronous Temporary Pacing after Cardiac Surgery

Preisman, Sergey; Cheng, Davy

doi:10.1097/00000542-199909000-00046

Cited by 26 publications

(11 citation statements)

References 2 publications

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“…Case 1 illustrates both poor pacing and poor sensing. In the event of poor sensing, stimulation (even at a relatively low voltage) in the repolarisation phase of the cardiac cycle is well recognised as a potential cause of ventricular fibrillation (the “R on T” phenomenon) and has been noted to occur in patients having treatment with a pacemaker 4 – 10…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

Pacemaker induced ventricular fibrillation in coronary care units

McLeod

Jokhi

2004

BMJ

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“…A sensing mode such as VVI or DDD was eschewed because of the unpredictability of the magnetic sensor (i.e., reed switch or Hall sensor) during MRI, 11 which may lead to prolonged asynchronous pacing. Despite claims to the contrary, 6,23 asynchronous pacing is not necessarily benign, 19,26–29 particularly when prolonged given the extended duration of many scans. Others share this concern 30,31 …”

Section: Rationale For and Programming Strategy During Mrimentioning

confidence: 99%

Magnetic Resonance Imaging of Implantable Cardiac Rhythm Devices at 3.0 Tesla

Gimbel¹

2008

Pacing Clinical Electrophis

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“…In the event of poor sensing, stimulation (even at a relatively low voltage) in the repolarisation phase of the cardiac cycle is well recognised as a potential cause of ventricular fibrillation (the "R on T" phenomenon) and has been noted to occur in patients having treatment with a pacemaker. [4][5][6][7][8][9][10] Repetitive ventricular activity is particularly common when a premature beat falls on the T wave of a beat with a preceding long cycle length (case 2). 4 11 Other conditions making repetitive ventricular activity more likely are hypoxia, cardiac ischaemia, myocardial disease, hypokalaemia, hypothermia, hypothyroidism, digoxin treatment, and drug induced prolongation of repolarisation.…”

Section: Discussionmentioning

confidence: 99%

Time

Hayes¹

2004

BMJ

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Life-threatening Ventricular Dysrhythmias with Inadvertent Asynchronous Temporary Pacing after Cardiac Surgery

Cited by 26 publications

References 2 publications

Pacemaker induced ventricular fibrillation in coronary care units

Pacemaker induced ventricular fibrillation in coronary care units

Magnetic Resonance Imaging of Implantable Cardiac Rhythm Devices at 3.0 Tesla

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