Emergency transvenous cardiac pacing placement using ultrasound guidance

Study objective: 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. Methods: 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. Results: 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. Conclusion: 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.