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Cardiac arrhythmias associated with prophylactic pacing during coronary angiography
Insights
Prophylactic pacemaker insertion during coronary angiography is not recommended for patients with normal heart rhythm. This study found no benefit and an increased risk of arrhythmias with routine pacing.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Coronary angiography can precipitate arrhythmias.
- The role of prophylactic pacemakers in preventing these complications is unclear.
Purpose of the Study:
- To evaluate the efficacy of prophylactic pacemaker insertion during coronary angiography.
- To compare arrhythmic complication rates in patients with and without pacemakers.
Main Methods:
- Analysis of data from 518 consecutive cardiac catheterizations.
- Comparison of arrhythmia incidence between patients with and without prophylactic pacemakers.
Main Results:
- No patients without pacemakers required pacing; 1 episode of ventricular fibrillation occurred.
- Patients with prophylactic pacemakers showed increased ventricular and supraventricular arrhythmias (p<0.013 and p<0.046, respectively).
- Two cases of pacemaker-associated ventricular fibrillation were observed.
Conclusions:
- Routine prophylactic pacemaker insertion is not warranted in patients undergoing coronary angiography with normal sinus rhythm and AV conduction.
- Further research is needed for patients with conduction system disease.
Abstract:
Data from 518 consecutive cardiac catheterizations were analyzed to test the value of prophylactic pacemaker insertion during coronary angiography and to compare the incidence of arrhythmic complications in patients with and without pacemakers. In patients without pacing (n = 273), 1 episode of ventricular fibrillation occurred, which responded promptly to defibrillation. Sinus bradycardia (fewer than 30 beats/min for 10 seconds) was recorded in 74 patients (27%) and required treatment in 30 (11%). No patient required or would have benefited from pacemaker placement. Of the 245 patients with prophylactic pacemakers, there was an increased incidence of all ventricular (9 vs 1; p less than 0.013) and supraventricular (5 vs 0; p less than 0.046) arrhythmias. Pacemaker-associated induction of ventricular fibrillation occurred in 2 patients and was clearly related to electrical stimulation during a normally non-vulnerable period of the cardiac cycle. In conclusion, routine prophylactic pacemaker insertion during coronary angiography is not warranted in patients with normal sinus rhythm and normal atrioventricular conduction. More information is needed to determine if pacing is needed in patients with conduction system disease.