Temporary transvenous pacing guided by the combined use of ultrasound and intracavitary electrocardiography: a feasible and safe technique

Figures

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  Fig. 1. Subcostal 4-chamber view (a) and apical 4-chamber view (b) demonstrating the temporary pacing electrode catheter (EC, arrows) into the right ventricle (RV). RV right ventricle, RA right atrium, LV left ventricle, LA left atrium

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  Fig. 2. Subcostal inferior vena cava (IVC) view demonstrating the EC entering (white arrow) and getting out (black arrow) the IVC in direction of the right heart chambers. RA right atrium, tv tricuspid valve, RV right ventricle

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  Fig. 3. Intracavitary electrocardiogram (ECG) technique attaching the electrodes of the EC (a, b) to a precordial lead (V1 in this case, c by a cable with an alligator clip on each end (d). Of note, while the alligator clip is attached to a precordial lead as seen by its suction cup, this is in fact registering the cardiac electrical activity from an intracavitary view, thus it is indistinct whether or not it is placed on the patient’s chest; ECG limb leads are placed in the usual fashion

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  Fig. 4. Intracavitary ECG (lead V1) showing the cardiac electrical activity when the EC is free-floating into the RV (a) and when this is contacting the endocardium of the RV (b), as demonstrated by a subepicardial injury pattern (arrow)

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  Fig. 5. Coronary sinus view, obtained from a foreshortened apical 4-chamber view. a Normal coronary sinus (arrow). b Dilated coronary sinus (arrows)

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  Fig. 6. Summary of the combined technique: ultrasound and intracavitary ECG technique for temporary transvenous pacing