Usefulness of atrial electrograms recorded via central venous catheters in the diagnosis of complex cardiac arrhythmias.
OBJECTIVE
To assess the role of intravascular atrial electrograms in improving the diagnosis of complex cardiac arrhythmias in critically ill patients.


METHODS
Prospective, clinical study comparing the accuracy of cardiac rhythm diagnosis using standard surface electrocardiogram (EKG) and intravascular atrial electrograms.


METHODS
Intensive care unit of a university teaching hospital.


METHODS
A total of 57 critically ill patients (44 cardiothoracic surgery, five acute myocardial infarction, two septic shock, six miscellaneous) with 85 complex cardiac arrhythmias that were unable to be diagnosed with certainty using the surface EKG.


METHODS
None.


RESULTS
The intravascular atrial electrogram altered diagnosis based on the surface EKG in 11 (13%) patients and confirmed rhythm diagnosis in 60 (71%) of 85 patients with arrhythmia. Of 61 patients with wide complex tachycardia, 40 (66%) were diagnosed as ventricular tachycardia (atrioventricular dissociation demonstrated on the atrial electrogram), and 11 (18%) as supraventricular tachycardia with aberrant conduction. Ten (16%) wide complex tachycardias could not be diagnosed with confidence using both surface EKG and intravascular electrogram. There were no adverse effects with this technique.


CONCLUSIONS
Intravascular atrial electrograms recorded via central venous catheters are useful in the diagnosis of complex cardiac arrhythmias, particularly ventricular tachycardia. The technique is safe, simple, and quick.
Donovan
K D
KD
Department of Intensive Care, Royal Perth Hospital, Western Australia.
Power
B M
BM
Hockings
B E
BE
Lee
K Y
KY
Barrowcliffe
M P
MP
Lovett
M
M
D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016275:Atrial Function / Q000502:physiology*; D006348:Cardiac Surgical Procedures; D002405:Catheterization, Central Venous; D016638:Critical Illness; D004562:Electrocardiography / Q000379:methods*; D004566:Electrodes; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies