Transoesophageal echocardiography allows bedside guidance of temporary pacing catheter placement a novel practical approach for the intensive care unit

D. W. Donker*, E. C. Cheriex, E. A.C. Bouman, E. Pragt, D. C.J.J. Bergmans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Transoesophageal echocardiography (TEE) is increasingly used by intensivists as a bedside diagnostic tool for cardiac and haemodynamic assessment. We emphasize the versatility of TEE as an on-site imaging modality in the ICU by demonstrating TEE-guided positioning of a temporary transvenous pacing lead. The case of a haemodynamically unstable, mechanically ventilated patient who suffered a subacute inferior myocardial infarction complicated by interventricular septal rupture is presented. After surgical closure of the defect, the patient had an insufficient underlying rhythm and required urgent cardiac pacing due to failure of the standard temporary epicardial leads. Patient transfer to a fluoroscopy suite for conventional pacing catheter guidance was considered impossible due to the patient's instability. Alternatively, a temporary pacing catheter was introduced transvenously and appropriate positioning in the right ventricular cavity was guided by TEE. By this means, inadvertant lead-related perforation of the infarcted septum or free wall, manipulation of the patch or dislodgement of the pulmonary artery catheter could successfully be avoided. In order to confirm the accuracy of TEE-based visualization of a temporary pacing lead, we performed an in-vitro experiment: an echocardiographic view was generated by installing a TEE probe and pacing lead in a water bath demonstrating excellent differential visibility of the catheter, tip and electrodes.The available literature supports our experience and favours TEE as a rather fast, practical and accurate on-site imaging modality for right ventricular pacing lead placement in the ICU. This novel approach has to the best of our knowledge not been described before and could be incorporated in a goal directed echocardiography training for non-cardiologist intensivists.

Original languageEnglish
Pages (from-to)206-209
Number of pages4
JournalNetherlands journal of critical care
Volume14
Issue number3
Publication statusPublished - Jun 2010
Externally publishedYes

Keywords

  • Focused echocardiography
  • Guidance of transvenous temporary pacing catheter
  • Intensive care unit
  • Transoesophageal echocardiography
  • Transvenous temporary cardiac pacing

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