Temporary transvenous pacing guided by the combined use of ultrasound and intracavitary electrocardiography: a feasible and safe technique

Temporary transvenous pacing is a crucial procedure in emergency and critical care medicine. While fluoroscopy guidance is considered the gold-standard to place the temporary pacing electrode catheter (EC), its use is usually limited by equipment availability and time. By contrast, ultrasound (US) guidance is a useful alternative, since it is widely available at the bedside, does not emit ionizing radiation and provides optimal times to active pacing with fewer complications. However, many times, in spite of visualizing the EC in the right ventricle using US, the pacing capture and sensing are not optimal, and thus, having an easily applicable method for best assessing this issue is desirable, especially if it could be combined with US without difficulties. With the purpose of illustrating the points made previously, the combined US-intracavitary electrocardiography technique is described in detail in this paper.