Transvenous Atrial Pacing in the Treatment of Refractory Ventricular Irritability

Abstract

Two patients are presented in whom transvenous pacing from the right atrium was employed to control repetitive ventricular tachycardia and ventricular fibrillation refractory to all anti-arrhythmic medications. Neither patient had atrioventricular block. Pacing was accomplished by means of a small transvenous wire guided into the right atrium using monitoring at the bedside. In the case of the 1st patient, a 69 yr. old woman with rheumatic heart disease, temporary transvenous electrodes had to be employed on 2 separate occasions, and a permanent transvenous subcutaneous atrial pacemaker was finally installed. In the 2nd case, a 48 yr. old woman with heart disease of unknown cause, pacing was discontinued after 4 days and she was maintained on antiarrhythmic drugs. Transvenous atrial pacing should be considered for the control of repetitive ventricular arrhythmias refractory to conventional treatment when there is no atrioventricular block.