Coronary and left ventricular pacing as standby in invasive cardiology

Coronary pacing using as unipolar negative electrode a guidewire placed in a coronary branch was tested in 349 sites of 300 consecutive patients undergoing coronary angio-plasty. It was possible for 339 sites (97%). The threshold currents ranged from 1 to 15 (mean ± standard deviation 3.4 ± 2.4) mA. Side effects were seen in 13 patients (4%): 6 (2%) had transient coronary spasm, 4 (1%) had diaphragmatic stimulation, and 3 (1%) had stinging pain at the skin electrode. Of the 10 cases with pacing failure, left ventricular pacing was successfully tested in 5 by introducing the coronary wire or another wire into the left ventricle. It yielded a threshold of 2–8 (3.2 ± 2.7) mA. Therapeutic pacing for significant bradycardia was required in 7 patients (2%). It was successful in all. Coronary or left ventricular pacing appears to be a simple and reliable temporary measure. When there is no wire in the coronary artery or for diagnostic catheterization, left ventricular pacing can be done using the same setup and any type of guidewire.