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Case Reports
. 2022 May 3;17(1):101.
doi: 10.1186/s13019-022-01849-z.

VDI pacing with temporary esophageal and transvenous pacemaker leads to treat post-cardiac surgery cardiogenic shock

Sameer Sharif  1   2 , Adel Dyub  3 , Craig Ainsworth  4   5
Affiliations
Case Reports

VDI pacing with temporary esophageal and transvenous pacemaker leads to treat post-cardiac surgery cardiogenic shock

Sameer Sharif et al. J Cardiothorac Surg. .

Abstract

Background: Post-operative atrio-ventricular (AV) block after cardiac surgery is not uncommon in high-risk patients.

Case presentation: Our case highlights the management of a 62-year-old female with cardiogenic shock post-cardiac surgery with concomitant complete heart block. With VVI pacing proving ineffective, it was postulated that the patient may benefit hemodynamically from AV sequential pacing, re-establishing her atrial kick. We describe a novel technique of attaching a temporary pacemaker wire to an orogastric tube to sense atrial p-waves and pace the ventricle transvenously to perform AV sequential pacing. This was done temporarily to stabilize the patient's hemodynamic status while awaiting a permanent pacemaker implantation.

Conclusions: In hemodynamically unstable post-cardiac surgery patients with complete heart block in whom VVI pacing fails to improve their clinical status, clinicians should consider VDI pacing with an orogastric atrial sensing pacemaker lead, in consultation with the cardiac surgeon and the electrophysiology team. Of note, the patient needs to have underlying organized atrial activity for this setup to work.

Keywords: Cardiogenic shock; Case report; Heart block; Pacing; Post-cardiac surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Pulmonary artery catheter output of the patient in the immediate post-operative period. B Electrocardiogram showing underlying complete heart block with a rate of 40 beats per minute after VVI pacing paused. C Pulmonary artery catheter output with the patient paced VVI at rate of 62 with a transvenous pacemaker 4 days after her admission
Fig. 2
Fig. 2
A Stiff wire pacemaker attached to an orogastric tube. B CXR of patient with a pulmonary artery catheter, endotracheal tube, mechanical mitral and aortic valve, orogastric tube, transvenous pacemaker with a left internal jugular introducer cordis, and a temporary pacemaker wire attached to an orogastric tube. C Same image as B with the yellow line demarcating the pulmonary artery catheter; red line demarcates the esophageal pacemaker lead; the white line demarcates the transvenous pacemaker lead. D Fluoroscopy image showing the pulmonary artery catheter, a transvenous pacemaker inserted through the femoral vein, and a pacemaker attached to an orogastric tube. E Same image as D with the yellow line demarcating the pulmonary artery catheter; the red line demarcates the esophageal pacemaker lead; the white line demarcates the transvenous pacemaker lead. F Electrocardiogram showing VDI pacing. G Pulmonary artery catheter output after the patient was being paced VDI
See this image and copyright information in PMC

References

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