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Emergency transvenous cardiac pacing placement using ultrasound guidance
P A Aguilera1, B A Durham, D A Riley
1Department of Emergency Medicine, Martin Luther King, Jr./Charles R. Drew Medical Center, and University of California Los Angeles School of Medicine, Los Angeles, CA.
Study Objective:
We describe 9 patients who underwent ultrasound-guided transvenous cardiac pacing in which ultrasonographic imaging was used to assist and confirm the placement of electrode catheters within the right ventricle.
Methods:
We prospectively enrolled consecutive patients with complete heart block who received emergency ultrasound-assisted transvenous cardiac pacing (TVCP). Emergency physicians performed both ultrasound scanning and placement of the TVCP electrodes at a busy urban teaching medical center.
Results:
Real-time ultrasound-guided TVCP was successful in 8 (88.9%) of the 9 patients studied. The pacing catheter was not adequately visualized in 1 patient who ultimately required placement by a cardiologist. Echocardiography was useful in identifying pacing catheter misplacement and subsequent successful repositioning in 3 patients.
Conclusion:
Emergency physicians should be aware that ultrasound technology could be useful in assisting TVCP in the emergency department setting. Further investigation is required to adequately evaluate this modality as a new indication for ED echocardiography.