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Temporary pacemaker use during coronary arteriography
1Department of Cardiology, St. Luke's-Roosevelt Hospital Center, New York, New York.
Insights
Using temporary pacemakers during coronary angiography increases ventricular arrhythmia risk. Placing pacing electrodes in the right atrium or vena cava, not the right ventricle, significantly reduces this risk in patients undergoing the procedure.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Temporary right ventricular pacemakers are associated with increased risk of ventricular arrhythmias during coronary angiography.
- The exact mechanism and the impact of electrode placement require further investigation.
Purpose of the Study:
- To evaluate the hypothesis that placing temporary pacing electrodes in the right atrium or vena cava reduces ventricular arrhythmias compared to right ventricular placement during coronary angiography.
- To assess the risk factors associated with ventricular arrhythmias in patients undergoing coronary angiography with temporary pacing.
Main Methods:
- Retrospective analysis of 7,648 patients undergoing cardiac catheterization and selective coronary angiography.
- Comparison of ventricular arrhythmia prevalence between patients with and without temporary pacemakers.
- Analysis of 369 procedures with concurrent temporary pacing, comparing arrhythmia rates based on electrode location (right ventricle vs. right atrium/vena cava).
Main Results:
- Patients with temporary pacemakers had a 6.4-fold higher prevalence of ventricular arrhythmias (7% vs. 1.1%).
- Ventricular arrhythmias were over 4 times less frequent when pacing electrodes were in the right atrium/vena cava compared to the right ventricle (2% vs. 9%).
- No significant difference in indications for pacing or arrhythmia occurrence based on electrode location was found.
Conclusions:
- Concurrent use of right ventricular temporary pacemakers during coronary angiography increases the risk of ventricular arrhythmias, particularly in patients with underlying conduction disturbances.
- Repositioning temporary pacing electrodes to the right atrium or vena cava significantly mitigates this risk.
- This finding supports a change in practice for temporary pacing during coronary angiography to improve patient safety.
Abstract:
The risk of life-threatening ventricular arrhythmias complicating coronary angiography is reportedly increased in patients in whom temporary righ ventricular pacemakers are used. Placement of the temporary pacing electrode in the right atrium or vena cava during angiography theoretically removes from the vulnerable ventricle a source of mechanically or electrically induced ventricular arrhythmias. This hypothesis was evaluated in 7,648 consecutive patients who underwent cardiac catheterization with selective coronary angiography, including 103 with life-threatening ventricular arrhythmic complications. The prevalence of ventricular arrhythmias was 6.4 times greater in patients with temporary pacemakers than in those without (7% vs 1.1%, respectively, p less than 0.001). Analysis of 369 cardiac catheterizations concurrently using temporary pacemakers revealed a greater than 4-fold decrease in the frequency of ventricular arrhythmias when the pacing electrodes were located in the right atrium or vena cava rather than the right ventricle (2% vs 9%, respectively, p less than 0.01). No significant difference in indications for temporary pacing could be distinguished between the groups based on location of the pacing electrode or occurrence of ventricular arrhythmias. These findings confirm that there is an increased risk of ionic contrast agent-induced ventricular arrhythmias in patients with chronic underlying conduction disturbances undergoing coronary angiography with concurrent right ventricular temporary pacemakers. This risk can be significantly decreased by placing the pacing electrode in the right atrium or vena cava.