title: Temporary trans-coronary pacing by coated guidewires: a safe and reliable method during percutaneous coronary intervention.
abstract: Relevant bradycardias during percutaneous coronary intervention (PCI) are a rare event, but they require immediate therapy by temporary pacing. However, transvenous pacing is associated with frequent and severe complications. Therefore, we wanted to evaluate the safety and reliability of trans-coronary pacing by means of a PCI guidewire. Coronary pacing was applied to 70 consecutive patients undergoing PCI. Pacing was performed before and after PCI in a unipolar setting using standard guidewires as a cathode and a skin electrode as an anode. Both were connected to an external pacemaker. Coronary pacing (maximum output at 10 V, impulse duration 2.5 ms) was effective in 60 of 70 patients (85.7%). Successful pacing was achieved in the LAD and diagonal branches in 90% (27 of 30 Pts.), in the LCX and marginal branches 84.2% (16 of 19 Pts.) and in the RCA in 81% (17 of 21 Pts.). Pacing thresholds were comparable in all vessels within a range of 1-10 V averaging 6.6 +/- 2.3 V before and 6.6 +/- 2.2 V after PCI. The impedance ranged from 190-544 Omega with mean pacing impedance for coronary pacing of 424 Omega before and 416 Omega after PCI, respectively. Significant bradycardias during PCI occurred in 7 cases (10%). In three cases (4.3%) temporary coronary pacing became necessary at a maximum pacing duration of 3 min. There were no severe side effects. Coronary spasm occurred in 3 cases (4.3%) after pacing and was promptly reversible after intracoronary application of nitroglycerine. It is concluded that coronary pacing is a safe and feasible method for the treatment of bradycardias during PCI. It avoids additional venous puncture under hemodynamically unstable conditions and subsequent transvenous pacing, which is accompanied by potentially severe complications and additional costs.
authors.affiliation: Division of Cardiology and Angiology, University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle, Germany. konstantin.heinroth@medizin.uni-halle.de
authors.forename: Konstantin M
authors.initials: KM
authors.lastname: Heinroth
authors.forename: Ina
authors.initials: I
authors.lastname: Stabenow
authors.forename: Ines
authors.initials: I
authors.lastname: Moldenhauer
authors.forename: Susanne
authors.initials: S
authors.lastname: Unverzagt
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Roland
authors.initials: R
authors.lastname: Prondzinsky
mesh_terms: D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001919:Bradycardia / Q000209:etiology; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000628:therapy*; D003329:Coronary Vasospasm / Q000209:etiology; D017097:Electric Impedance; D004567:Electrodes, Implanted; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D015203:Reproducibility of Results; D012107:Research Design; D013577:Syndrome; D016896:Treatment Outcome