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Emergency defibrillation using a temporary pacing electrode catheter.

D E Mann, I K Inouye, V Sakun

    Pacing and Clinical Electrophysiology : PACE
    |September 1, 1985
    PubMed
    Summary
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    Intractable ventricular fibrillation (VF) unresponsive to external shocks was successfully treated with intracardiac shocks. This case demonstrates a novel approach using a temporary pacing catheter for refractory VF.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Critical Care Medicine

    Background:

    • Recurrent ventricular tachyarrhythmias are often managed with implantable defibrillators or specialized catheters.
    • Electrical cardioversion is a standard treatment for life-threatening arrhythmias like ventricular fibrillation (VF).

    Observation:

    • A patient undergoing electrophysiologic testing developed intractable ventricular fibrillation (VF) lasting 50 minutes.
    • Multiple high-energy transthoracic shocks (360 joules) failed to convert the persistent VF.
    • Intracardiac shocks were delivered using a standard transvenous pacing catheter positioned in the right ventricular apex.

    Findings:

    • Up to 300 joules delivered via intracardiac shocks were ineffective in defibrillating the patient.
    • A 360-joule intracardiac shock successfully converted the refractory ventricular fibrillation twice.

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  • The patient recovered fully without any neurological or cardiac sequelae despite prolonged cardiac arrest.

    • Implications:

    • Intracardiac shocks via a temporary pacing catheter may be a viable alternative for refractory ventricular fibrillation.
    • This method offers a potential treatment option when standard transthoracic defibrillation fails.
    • Further investigation into intracardiac shock delivery for refractory VF is warranted.