[Temporary emergency cardiac pacing under continuous echocardiographic control. Feasibility and safety of the procedure without using fluoroscopy].
BACKGROUND
Cardiac pacing often turns out to be the only effective treatment of severe brady-arrhythmias. Several invasive and noninvasive temporary pacing procedures are known, whose application is sometimes difficult or time-consuming. An alternative temporary cardiac pacing procedure is described in this article, which is based on echocardiographic control.


METHODS
Fifty-four nonconsecutive patients were studied; they all were needing urgent cardiac pacing. A first choice attempt to perform an ultrasound-guided temporary cardiac pacing, by using a right jugular venous approach, was done. The catheter pathway was monitored by means of echocardiography performed by another operator. All data concerning time of execution, pacing parameters, acute or chronic complications and the in situ time duration of the catheter without needing to be repositioned were obtained.


RESULTS
Ultrasound-guided cardiac pacing was not feasible in 3 patients (6%), because of a high thoracic acoustic impedance or failing to perform right jugular venous catheterization. Mean execution time was 680 +/- 179 s. Echocardiographic monitoring was performed in 50 patients by a cardiologist, in 1 patient by a non-cardiologist physician, and in 3 patients by a nurse, who had been previously trained to keep the transducer in the right position. No serious complications occurred. On 4 occasions (8%) the catheter had to be repositioned during the following hours. On 25 occasions (46%) permanent cardiac pacing was finally performed.


CONCLUSIONS
Temporary ultrasound-guided cardiac pacing seems to be a safe and easy procedure; it can be performed in a broad range of clinical and logistic scenarios and does not require fluoroscopic monitoring. A limited number of human resources is needed, but technical skills in central venous catheterization are required. Further studies are needed to validate this procedure; however it shows several potential benefits as compared to the other temporary cardiac pacing techniques.
Pinneri
Francesco
F
Divisione di Cardiologia Ospedale Civico ASL 7 Corso Galileo Ferraris, 3 10034 Chivasso, TO. pinnerif@libero.it
Mazza
Antonio
A
Garzaro
Luca
L
Galeazzi
Marco
M
De Felice
Francesco
F
Russo
Maurizio
M
Dottori
Melissa
M
Madama
Giuseppe
G
Recanzone
Pierantonio
P
Kamal
Najd
N
Rizzotti
Michele
M
Panella
Silvana
S
Valentini
Giuliano
G
Tos
Giovanna Giglio
GG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D002405:Catheterization, Central Venous; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010138:Pacemaker, Artificial; D012449:Safety; D013997:Time Factors