Ultrasound-guided positioning of temporary pacing catheters and pulmonary artery catheters after echogenic marking.

Pacing of the heart is one of the most effective emergency measures in the management of critical bradycardic arrhythmias. Positioning of the pacing catheter is safest under fluoroscopic control; however, this facility is not always readily available in emergency situations. A procedure was therefore developed by which pacing catheters could be easily positioned under echocardiographic control after echogenic marking. It involves the filling of commercially available balloon-tipped pacing catheters with an echogenic substance consisting of galactose microparticles suspended before use in a 0.9% saline solution (Echovist). The balloon on the pacing catheter is then easy to locate intravascularly by ultrasound and can be visually guided into the right ventricle. To date, this method has been used effectively and without complication to position both pacing catheters and pulmonary artery catheters.