Bedside temporary pacemaker placement
The primary access site was through the right internal jugular vein (16 cases, 73%), followed by subclavian vein (4 cases, 18%) when surgery involved the right neck. The femoral vein approach was used (2 cases, 9%) after difficulty was experienced in advancing TVCP catheter through the subclavian vein or right internal jugular vein site. Except for subclavian vein access, all central venous access was under ultrasound guidance.
Pacing catheterization guided by bipolar (both proximal electrode and distal electrode connect to separate V lead) intracavity electrocardiography (IC-ECG).14, 15The bipolar IC-ECG monitoring plus direction control skill of the catheter tip made bedside TVCP catheter placement feasible and ‘visible’.14Target proximal electrode IC-ECG was slightly ST-segment elevation <2 mV which constitute a proper position against the ventricular wall and adequate pacing site,16 but it is impossible to maintain it if patient change positions (Fig 1). All placement was further confirmed by following standard 6-lead pacing ECG that II, III, and aVF QRS waves downward.
Figure 1. Unstable pacing lead.