Abstract
✓ Temporary tachycardia of 130 to 160 beats/min was induced with a bipolar endocardial catheter pacemaker in 13 patients undergoing intracranial vascular surgery (nine for aneurysms, one for an arteriovenous anomaly, and three for brain tumors). It proved to be an effective method for achieving controlled hypotension of 25 to 40 mm Hg. Electrical pacing of the heart reduced diastolic filling time, lowered cardiac output, and produced systemic hypotension which was inversely proportional to the induced heart rate. Twelve patients made uneventful recoveries. One patient sustained intractable ventricular fibrillation while being paced at a rate of 180 to 190 beats/min and died. One patient developed transient ventricular fibrillation which was successfully converted. Cessation of pacing produced immediate return of systolic pressures to the prepacing levels. Although not without hazard, rapid ventricular pacing is recommended as an effective method for transiently lowering systemic blood flow during periods of potential or actual hemorrhage in intracranial vascular surgery.
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