Use of temporary pacemakers during coronary angioplasty: An evolving experience with ventricular fibrillation in 400 cases

Abstract

Because of a perceived high frequency of ventricular fibrillation when a pacemaker catheter was placed in the right ventricular apex during PTCA, we reviewed our first 400 cases for this complication. The incidence of ventricular fibrillation in the entire group was 10 of 400 cases (2.5%) compared with 17 of 3,806 (0.4%) diagnostic coronary arteriograms performed in our laboratory during the same time period (P less than .001). Ventricular fibrillation occurred more frequently during PTCA when the pacemaker catheter tip was placed in the right ventricular apex (8 of 63 cases, 12.6%) than when it was positioned in either the pulmonary artery, vena cava, or when a pacemaker catheter was not used (2 of 337 cases, 0.6%, P less than .001). Based on these data we have developed a policy of inserting temporary pacemakers prophylactically during PTCA only for patients undergoing dilation of dominant right or dominant left circumflex coronary arteries and in patients with acute myocardial infarction.

Successful coronary pace-termination of ventricular tachycardia during coronary angioplasty

“…The patient was discharged well the next day. [1] first described the technique of coronary pacing during PTCA to avoid additional venous puncture and the associated complications of transvenous pacing wires [2][3][4][5][6]. The value of the technique was further demonstrated prospectively in a group of 300 patients undergoing PTCA by de la Serna et al [7]: 7 patients (2%) required pacing for bradycardias but not for tachycardias.…”

Percutaneous transluminal coronary angioplasty: A review of current balloon dilatation systems

“…The necessity of the use of a temporary pacing catheter during angioplasty has been questioned [44]; this may add $100 or more to the cost of the procedure. Also, the use of continuous infusion heparin for 18-24 hours after angioplasty as opposed to sheath removal the same day, as well as post-PTCA recovery in a standard hospital bed, telemetry bed, or intensive care unit, all directly influence the overall cost of the procedure.…”