Temporary transmyocardial pacing using epicardial pacing wires and pacing pulmonary artery catheters.

This study investigated the feasibility of transmyocardially pacing the heart using one temporary epicardial pacing lead and one endocardial lead of a pacing pulmonary artery catheter. Twenty patients undergoing cardiopulmonary bypass with cardioplegic arrest were studied 10 to 45 minutes and 18 to 30 hours after discontinuation of cardiopulmonary bypass. The Swan-Ganz Flow-Directed Pacing TD Catheter (Baxter Healthcare Corporation) was inserted in one group of 10 patients, and the Swan-Ganz Thermodilution A-V Paceport Catheter (Baxter Healthcare Corporation, Irvine, CA) was used in another group of 10 patients. Using the Pacing TD Catheter, transmyocardial atrial (TMA) pacing was successful in 14 of 16 attempts (87.5%), and transmyocardial ventricular (TMV) pacing was successful in 15 of 16 attempts (93.8%). With the AV Paceport Catheter, TMA pacing was successful in 16 of 18 attempts (88.9%), and TMV pacing was successful in 17 of 19 attempts (89.5%). Transmyocardial atrial-ventricular sequential pacing was achieved in all cases when both TMA and TMV pacing were independently successful. There were no significant differences between catheters in the success rates of either TMA or TMV. It is concluded that transmyocardial pacing is feasible using one temporary epicardial pacing lead and one endocardial lead of a pacing pulmonary artery catheter.