CORONARY AND LEFT-VENTRICULAR PACING AS STANDBY IN INVASIVE CARDIOLOGY

Coronary pacing using as unipolar negative electrode a guidewire place d in a coronary branch was tested in 349 sites of 300 consecutive pati ents undergoing coronary angioplasty. It was possible for 339 sites (9 7%). The threshold currents ranged from 1 to 15 (mean +/- standard dev iation 3.4 +/- 2.4) mA. Side effects were seen in 13 patients (4%): 6 (2%) had transient coronary spasm, 4 (1 %) had diaphragmatic stimulati on, and 3 (1%) had stinging pain at the skin electrode. Of the 10 case s with pacing failure, left ventricular pacing was successfully tested in 5 by introducing the coronary wire or another wire into the left v entricle. It yielded a threshold of 2-8 (3.2 +/- 2.7) mA. Therapeutic pacing for significant bradycardia was required in 7 patients (2%). It was successful in all. Coronary or left ventricular pacing appears to be a simple and reliable temporary measure. When there is no wire in the coronary artery or for diagnostic catheterization, left ventricula r pacing can be done using the same setup and any type of guidewire.