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Coronary and left ventricular pacing as standby in invasive cardiology
F de la Serna1, B Meier, A K Pande
1Cardiology Center, University Hospital, Geneva, Switzerland.
Insights
Coronary pacing using a guidewire proved highly successful in 97% of patients during angioplasty. This simple technique offers a reliable temporary pacing solution for bradycardia and can be adapted for left ventricular pacing.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Temporary cardiac pacing is crucial during interventional procedures.
- Current methods can be invasive or technically challenging.
Purpose of the Study:
- To evaluate the efficacy and safety of coronary pacing using a guidewire as the negative electrode.
- To assess the feasibility of left ventricular pacing with the same setup.
Main Methods:
- A unipolar negative electrode guidewire was placed in a coronary branch in 300 patients undergoing coronary angioplasty.
- Pacing thresholds and side effects were recorded.
- Left ventricular pacing was attempted in cases of pacing failure.
Main Results:
- Coronary pacing was successful in 339 out of 349 sites (97%).
- Mean threshold current was 3.4 ± 2.4 mA.
- Minor side effects (coronary spasm, diaphragmatic stimulation, skin pain) occurred in 4% of patients.
- Left ventricular pacing was successful in 5 of 10 attempts with a mean threshold of 3.2 ± 2.7 mA.
- Therapeutic pacing for bradycardia was successful in all 7 patients requiring it.
Conclusions:
- Coronary pacing using a guidewire is a simple, reliable, and effective temporary pacing method.
- This technique can be readily adapted for left ventricular pacing.
- It offers a valuable alternative for temporary cardiac pacing during interventional cardiology procedures.
Abstract:
Coronary pacing using as unipolar negative electrode a guidewire placed in a coronary branch was tested in 349 sites of 300 consecutive patients undergoing coronary angioplasty. It was possible for 339 sites (97%). The threshold currents ranged from 1 to 15 (mean +/- standard deviation 3.4 +/- 2.4) mA. Side effects were seen in 13 patients (4%): 6 (2%) had transient coronary spasm, 4 (1%) had diaphragmatic stimulation, and 3 (1%) had stinging pain at the skin electrode. Of the 10 cases with pacing failure, left ventricular pacing was successfully tested in 5 by introducing the coronary wire or another wire into the left ventricle. It yielded a threshold of 2-8 (3.2 +/- 2.7) mA. Therapeutic pacing for significant bradycardia was required in 7 patients (2%). It was successful in all. Coronary or left ventricular pacing appears to be a simple and reliable temporary measure. When there is no wire in the coronary artery or for diagnostic catheterization, left ventricular pacing can be done using the same setup and any type of guidewire.