• Vol. 41 No. 9, 417–419
  • 15 September 2012

Right Pace, Wrong Place



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We report a 61-year-old Chinese man with end-stage renal failure who was admitted for late stent thrombosis of the right coronary artery bare metal stent 5 months after the index percutaneous coronary intervention. Successful thrombectomy and balloon angioplasty was performed with intravascular ultrasound guidance. During his stay in the coronary care unit (CCU), he developed intermittent complete heart block and frequent runs of bradycardia-induced torsades de pointes which resulted in cardiogenic shock. Temporary pacing wire insertion was planned to prevent further episodes. Due to profound hypotension, it was deemed unsafe to transfer the patient to the fluoroscopy room. Instead a balloon-tipped temporary pacing wire was to be inserted at bedside. The 6 Fr vascular sheath was inserted under assisted ultrasound localisation of the right internal jugular vein, followed by the insertion of the pacing wire. The pacing threshold was noted to be high at 3 mV. The electrocardiogram (ECG) post pacing wire insertion is shown in Figure 1a.

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