Bedside transvenous cardiac pacing

Abstract

P ermanent and temporary transvenous endocardial pacing has become widely accepted since the initial clinical report in 1959.1 It is effective in complete heart block with ildams-Stokes seizures” or congestive heart failure,3 in marked brad?-cardia or complete heart block following acute myocardial infarction,” and in digitalis-induced arrhythmias with high degrees of atrioventricular (-4-V) block.” It is efficacious in resuscitation after cardiac arrest6 and for control of ventricular tachg-arrhythmias.7 Alan)of these problems are therapeutic emergencies with insufficient time for patient transport to medical centers where the majority of pacemaker insertions are performed. Even with suitable facilities, patients must be moved from bed to fluoroscopy unit, which ma!. be hazardous for the acutely ill patient. It has been estimated that at least 4.5 minutes is required for transport of a patient to a fluoroscopgunit, assembly of the necessary personnel, a’nd insertion of a transvenous electrode with stable pacing. The com1~1o1~1y used pacemaker catheterst may be stiff, and perforation of the heart or vessels result from their blind insertion.2s6 A soft, flexible electrode wire catheter (Flexon steel wire electrodcfj inserted at the bedside without the aid of Auoroscopy8-12 has obviated this hazard. However, published experience with this method of transvenous insertion is limited. In our hands, the Flexon steel wire was too light and flexible causing difficulty in manipulation and inconsistent pacing. This report details our experience with 102 patients using a new Elecath “Semi-Floating” (S-F)$ transvenous pacemaker catheter for bedside insertion. These results will be compared with 19 cases using the I+Yexon steel wire electrode. During an 8 month period, 111 patients, ranging in age from 32 to 96, had bedside transvenous pacemaker insertions. The indications for pacing are listed in Table I. The miscellaneous group included several