ABSTRACT
Relevant bradycardias during percutaneous coronary intervention (PCI) are a rare event, but they require immediate therapy by temporary pacing. However, transvenous pacing is associated with frequent and severe complications. Therefore, we wanted to evaluate the safety and reliability of trans-coronary pacing by means of a PCI guidewire. Coronary pacing was applied to 70 consecutive patients undergoing PCI. Pacing was performed before and after PCI in a unipolar setting using standard guidewires as a cathode and a skin electrode as an anode. Both were connected to an external pacemaker. Coronary pacing (maximum output at 10 V, impulse duration 2.5 ms) was effective in 60 of 70 patients (85.7%). Successful pacing was achieved in the LAD and diagonal branches in 90% (27 of 30 Pts.), in the LCX and marginal branches 84.2% (16 of 19 Pts.) and in the RCA in 81% (17 of 21 Pts.). Pacing thresholds were comparable in all vessels within a range of 1-10 V averaging 6.6 +/- 2.3 V before and 6.6 +/- 2.2 V after PCI. The impedance ranged from 190-544 Omega with mean pacing impedance for coronary pacing of 424 Omega before and 416 Omega after PCI, respectively. Significant bradycardias during PCI occurred in 7 cases (10%). In three cases (4.3%) temporary coronary pacing became necessary at a maximum pacing duration of 3 min. There were no severe side effects. Coronary spasm occurred in 3 cases (4.3%) after pacing and was promptly reversible after intracoronary application of nitroglycerine. It is concluded that coronary pacing is a safe and feasible method for the treatment of bradycardias during PCI. It avoids additional venous puncture under hemodynamically unstable conditions and subsequent transvenous pacing, which is accompanied by potentially severe complications and additional costs.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Cardiac Pacing, Artificial , Coronary Artery Disease/therapy , Acute Disease , Aged , Angina Pectoris/therapy , Angioplasty, Balloon, Coronary/adverse effects , Bradycardia/etiology , Cardiac Pacing, Artificial/adverse effects , Coronary Vasospasm/etiology , Electric Impedance , Electrodes, Implanted , Equipment Design , Equipment Safety , Feasibility Studies , Female , Germany , Humans , Male , Middle Aged , Pacemaker, Artificial , Reproducibility of Results , Research Design , Syndrome , Treatment OutcomeABSTRACT
OBJECTIVES: Cytokines contribute to the development of the systemic inflammatory response syndrome or multiple-organ failure frequently observed after cardiopulmonary bypass-supported cardiac surgery. To quantify the contribution of bypass-induced versus trauma-induced inflammatory response after coronary artery bypass grafting, we examined plasma cytokine levels in 120 patients with coronary artery disease who were treated with or without cardiopulmonary bypass-assisted procedures. METHODS: Patients were treated in accordance with one of the following protocols: (1) elective percutaneous coronary intervention without cardiopulmonary bypass (n = 69), (2) cardiopulmonary bypass-supported percutaneous coronary intervention (cardiopulmonary bypass-percutaneous coronary intervention; n = 10), and (3) cardiopulmonary bypass-supported coronary artery bypass grafting (cardiopulmonary bypass-coronary artery bypass grafting; n = 41). Cytokine levels (picograms/milliliter) were measured by enzyme-linked immunosorbent assay from plasma samples obtained at various time points. RESULTS: Interleukin-6 was measured in blood samples from all 3 patient populations. The maximum interleukin-6 level was 13.6 +/- 22.3 pg/mL in the percutaneous coronary intervention group, 170.4 +/- 165.4 pg/mL in the cardiopulmonary bypass-percutaneous coronary intervention group, and 640.3 +/- 285.7 pg/mL in the cardiopulmonary bypass-coronary artery bypass grafting group. Interleukin-6 levels were significantly different, and the 95% confidence intervals did not overlap. In the cardiopulmonary bypass-percutaneous coronary intervention group, bypass duration correlated well with interleukin-6 production ( r = 0.915; P < .001), whereas these parameters did not correlate in patients who underwent cardiopulmonary bypass-coronary artery bypass grafting ( r = 0.307; P = .054). CONCLUSIONS: These findings support the suggestion that surgical trauma and cardiopulmonary bypass contribute to the inflammatory response after cardiac surgery, although trauma may contribute to a higher degree.
