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Temporary pacemaker use during coronary arteriography.

I C Gilchrist1, A Cameron

  • 1Department of Cardiology, St. Luke's-Roosevelt Hospital Center, New York, New York.

The American Journal of Cardiology
|November 1, 1987
PubMed
Summary
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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.

Related Experiment Videos

  • 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.