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Ann Thorac Surg 2000;69:1301-1302
© 2000 The Society of Thoracic Surgeons

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CORRESPONDENCE

Transatrial cardiac pacing

^a Cardiopulmonary Transplantation, Harper Hospital, 3990 John R, Ste 2102, Detroit, MI 48201, USA

To the Editor

We enjoyed the recent article by Dr Goldstein and colleagues [1], and have used a similar approach for venous access to place a DDDR pacing system in three recent patients. The first was a femoral hemodialysis patient with inaccessible venous access and nonfunctioning epicardial pacemaker lead [2], the second a former intravenous drug abuser without venous access, and the third a peritoneal dialysis patient without venous access, a nonfunctioning epicardial lead, and right chest air leak from a ruptured apical bleb. The third patient also underwent apical bleb resection and pleurodesis at the time of the transatrial pacemaker insertion.

The patients requiring the transatrial leads were similar to those in Dr Goldstein’s series—patients without venous access because of chronic dialysis, intravenous drug abuse, and who frequently had epicardial lead failure.

Our technique has several minor differences. We use a right mediastinotomy approach with resection of only the second costocartilage. The right internal thoracic artery is not sacrificed. Pursestring sutures are placed in the right atrium and the pacing leads inserted directly through the pursestring without using an introducer. All patients have bipolar leads. All patients have atrial and ventricular leads placed for DDDR pacing. The pacemaker generator was placed in the standard right infraclavicular position. Chest tubes have not been left in place with the exception of the patient who also had an apical bleb resection.

The leads have had good acute and chronic sensing and pacing thresholds. In addition, the patients have not experienced postoperative arrhythmias, pneumothorax, bleeding, or infectious complications.

We agree that this approach is a way of achieving transvenous biventricular pacing in a select patient population with minimal morbidity.

References

1. Goldstein D.J., Rabkin D., Spotnitz H.M. Unconventional approaches to cardiac pacing in patients with inaccessible cardiac chambers. Ann Thorac Surg 1999;67:952-958.[Abstract/Free Full Text]
2. Baciewicz F.A. Transthoracic pacemaker lead insertion via the right atrium. Thorac Cardiovasc Surg 1998;46:370-371.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Frank A. Baciewicz, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baciewicz, F. A. Articles by Jackson, K. Search for Related Content PubMed Articles by Baciewicz, F. A., Jr Articles by Jackson, K.