Emergency guide wire pacing: new methods for rapid conversion of a cardiac catheter into a pacemaker

We developed a new electrode to convert rapidly a previously inserted pulmonary artery or left ventricular catheter into a pacemaker. One method of doing this is by withdrawal of the pulmonary artery catheter from the pulmonary artery to the right ventricle by pressure control, and a Teflon-coated guide wire, stripped of 5 mm of insulation at its tip, is advanced through the catheter to contact the endocardium. In the second method, the pacing electrode is advanced through the distal lumen of the catheter while it is positioned within the pulmonary artery and withdrawn into the right ventricle while pacing. Finally, a third method involves advancement of the guide wire electrode into the left ventricle through a pigtail catheter. To pace, the guide wire electrode is connected to the cathode of a pacemaker referenced to a skin electrode. We paced 10 of 10 right heart cardiac catheterization, intra- and postoperative surgery patients by methods 1 and 2, and 4 of 4 left heart catheterization patients by method 3. Thresholds (mean +/- SEM) for guide wire pacing were: right ventricle 1.52 +/- 0.4 mA; left ventricle 1.33 +/- 0.1 mA. Guide wire pacing is rapid, reliable, and requires little operator skill. Our indications for guide wire pacing are: 1) emergency right ventricular pacing in operative or intensive care unit patients with unexpected bradyarrhythmias who have an indwelling pulmonary artery catheter; and 2) emergency left ventricular pacing in left heart cardiac catheterization patients with contrast-induced bradyarrhythmias.