Feasibility of peripheral venous access for temporary right ventricular pacing

INTRODUCTION

In this brief report, we present our experience from placing temporary pacing electrodes through peripheral venous access sites, at bedside, in a series of patients needing temporary pacing.

METHODS

Consecutive patients requiring temporary pacing were selected. The median cubital or the basilic vein of the left upper extremity were used for catheterization at the bedside in all cases.

RESULTS

25 patients (17 men, age 64.6 ± 11.8) were included. The procedure was successful in 21 cases (84%), 18 of which were completed without the need for fluoroscopic guidance. The pacing leads remained for 4.2 ± 2.2 days. As expected, no serious complications related to venous puncture were observed. Although patients were allowed to be mobilized within the ward and engage in limited movements of the catheterized arm, in only one case was the lead displaced, requiring repositioning.

CONCLUSIONS

We provide observational evidence that the use of peripheral venous access for temporary pacing lead insertion (with no fluoroscopic guidance, as default strategy) is a safe and feasible choice that might be considered as an alternative to central vein catheterization.

Role of grey-scale intravascular ultrasound and ChromaFlo in deciding on treatment approach for spontaneous coronary dissection in a young woman

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes. We present the case of a young woman with an acute coronary syndrome caused by SCAD, where grey-scale intravascular ultrasound (IVUS) and ChromaFlo were instrumental in deciding against interventional treatment. The patient's urgent angiogram gave the impression of a spiral dissection in the right coronary artery. IVUS confirmed the presence of an intimal flap and the ChromaFlo study showed unobstructed flow throughout the dissected segments. No atherosclerotic plaques or intramural hematomas were imaged on the IVUS pullback. In this case, grey-scale IVUS was used to confirm the absence of atherosclerotic coronary artery disease and ChromaFlo to assess flow in the true and the false lumen, excluding the presence of no-flow intramural hematomas. Based on these findings, it was decided to adopt a conservative treatment strategy.

Transradial access as first choice for primary percutaneous coronary interventions: experience from a tertiary hospital in Athens

INTRODUCTION

The transfemoral approach (TFA) has been the mainstay for arterial access during percutaneous coronary intervention (PCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI). However, the transradial approach (TRA) has been shown to be an equally effective and possibly safer way of performing primary PCI (pPCI).

METHODS

The study population included 98 serially recruited patients who underwent pPCI in our institution. All patients were clinically followed during their hospital stay (6.4 ± 3.1 days).

RESULTS

In the 98 patients included in the study, 65 procedures (66.3%) were completed via TRA, whereas the remaining 33 procedures (33.7%) used TFA. Door-to-balloon time was similar (57 ± 19 min vs. 54 ± 15 min, p=ns). Patients in the TRA group were mobilized sooner (28 ± 9 hours vs. 36 ± 13 hours, p<0.05). Hospital stay was significantly shorter in the TRA group (6.0 ± 3.2 days vs. 7.1 ± 2.8 days, p<0.05). TRA and TFA did not differ significantly as to the incidence of death, non-fatal myocardial infarction or subacute stent thrombosis, but major access-related vascular complications were significantly more frequent in the TFA group (2% vs. 15%, p<0.01). Cerebrovascular events did not differ between TRA and TFA.

CONCLUSIONS

Compared to TFA, TRA seems to be associated with a lower incidence of bleeding complications, as well as earlier mobilization and discharge from hospital. It is conceivable that TRA could become the first choice in the treatment of STEMI patients in the near future, while TFA is kept as an alternative.