Emergency transvenous cardiac pacing placement using ultrasound guidance.

Abstract

We describe 9 patients who underwent ultrasound-guided transvenous cardiac pacing in which ultrasonographic imaging was used to assist and confirm the placement of electrode catheters within the right ventricle. We prospectively enrolled consecutive patients with complete heart block who received emergency ultrasound-assisted transvenous cardiac pacing (TVCP). Emergency physicians performed both ultrasound scanning and placement of the TVCP electrodes at a busy urban teaching medical center. Real-time ultrasound-guided TVCP was successful in 8 (88.9%) of the 9 patients studied. The pacing catheter was not adequately visualized in 1 patient who ultimately required placement by a cardiologist. Echocardiography was useful in identifying pacing catheter misplacement and subsequent successful repositioning in 3 patients. Emergency physicians should be aware that ultrasound technology could be useful in assisting TVCP in the emergency department setting. Further investigation is required to adequately evaluate this modality as a new indication for ED echocardiography.