C93. Temporary Pacemaker Lead Insertion with Echocardiography Guided Technique in Emergency Setting: a Case Report

The implantation of the temporary pacemaker (TPM) must be done in symptomatic bradycardia to provide adequate heart rate and stabilize hemodynamic. Transvenous TPM is inserted under the fluoroscopy guidance. However, in an extraordinary situation, such as the unavailability of the catheterization laboratory, transvenous TPM insertion can be performed with echocardiography guiding.

A 27 years old male came to our ER with symtomatic bradicardia. Emergency procedure like medical treatment and transcutaneous pacing were done, but failed to increase heart rate. We planned transvenous pacing with fluoroscopy but the catheterization laboratory was not immediately available. Echocardiography guided temporary pacemaker were done in ER successfully and the patient was strabilized.

Emergency transvenous pacemaker implantation with echocardiography guiding can be accomplished successfully in our case without complication. There are several techical aspect that we should consider in temporary pacemaker insertion without fluoroscopy. We use femoral access and with echocardiography guided in our case. The confirmation of the lead placement using fluoroscopy was needed to ensure that the tip of the electrode was in the proper position. Future research that focuses on the safety and effectiveness of the technique across the range of operator skill levels is needed.