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Backup right ventricular pacing with a 0.035'' guidewire during implantation of left ventricular leads

Haran Burri1, Henri Sunthorn, Marc Zimmermann

  • 1Cardiology Service, University Hospital of Geneva, Geneva, Switzerland. haran.burri@hcuge.ch

Pacing and Clinical Electrophysiology : PACE
|March 3, 2009
PubMed

Insights

Temporary right ventricular (RV) pacing using a guidewire is a safe backup during biventricular device implantation. This method effectively manages complete heart block without interfering with the procedure.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Biventricular device implantation carries a risk of right bundle injury and complete heart block during coronary sinus (CS) ostium localization.
  • Current preventive measures, like early right ventricular (RV) lead implantation, can hinder guiding sheath manipulation and dislodge leads.

Purpose of the Study:

  • To evaluate the feasibility of using a 0.035'' guidewire for temporary RV backup pacing during CS localization in biventricular device implantation.

Main Methods:

  • A 0.035'' guidewire was advanced through the guiding sheath into the RV in 106 patients undergoing biventricular device implantation.
  • Unipolar capture threshold, R-wave sensing amplitude, and pacing impedance were measured to assess pacing efficacy.

Main Results:

  • Successful RV pacing was achieved in all patients.
  • Mean capture threshold was 3.8 V/0.5 ms, R-wave amplitude 5.4 mV, and pacing impedance 226 Ohms.
  • Two patients with complete heart block were successfully temporarily paced using the guidewire.

Conclusions:

  • Temporary RV pacing with a 0.035'' guidewire is a simple, reliable, and safe backup strategy.
  • This method effectively manages traumatic complete heart block during biventricular device implantation.
Abstract

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