Gilchrist I C, Cameron A
Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York.
Cathet Cardiovasc Diagn. 1988;15(4):229-32. doi: 10.1002/ccd.1810150404.
A retrospective analysis of 217 consecutive patients with chronic bundle branch blocks undergoing cardiac catheterization was done to evaluate the need for temporary transvenous pacing during coronary arteriography. In patients without temporary right ventricular pacemakers (n = 185), only one episode of high-grade atrioventricular block occurred during coronary arteriography which required the urgent use of temporary pacing. All other bradyarrhythmias, including five episodes of transient asystole (greater than 3-sec pause) and four episodes of atrioventricular block (second degree or higher) were successfully managed without pacemaker utilization. Patients with prophylactic right ventricular pacemakers (n = 32) had a greater prevalence of ventricular fibrillation than those without pacing electrodes located in the right ventricle (2% vs. 9% respectively; P less than 0.05). These findings suggest that routing prophylactic pacemaker insertion during coronary arteriography in patients with chronic bundle branch block is not warranted and may place the patient at risk for developing iatrogenic ventricular arrhythmias.
对217例连续接受心脏导管插入术的慢性束支传导阻滞患者进行了回顾性分析，以评估冠状动脉造影期间临时经静脉起搏的必要性。在没有临时右心室起搏器的患者（n = 185）中，冠状动脉造影期间仅发生1例高级别房室传导阻滞，需要紧急使用临时起搏。所有其他缓慢性心律失常，包括5例短暂心脏停搏（停顿大于3秒）和4例房室传导阻滞（二度或更高），在未使用起搏器的情况下均成功处理。有预防性右心室起搏器的患者（n = 32）比右心室内没有起搏电极的患者发生心室颤动的患病率更高（分别为2%和9%；P < 0.05）。这些发现表明，在慢性束支传导阻滞患者的冠状动脉造影期间常规插入预防性起搏器是不必要的，且可能使患者面临发生医源性室性心律失常的风险。
