Use of balloon flotation pacing catheters for prophylactic temporary pacing during diagnostic and therapeutic catheterization procedures.

The use of prophylactic temporary pacemakers during diagnostic catheterization, coronary angioplasty and percutaneous balloon valvuloplasty was investigated retrospectively over an 18-month period. Balloon flotation temporary pacemaker leads were placed in 193 (12%) of 1,609 patients undergoing diagnostic catheterization, 641 (65%) of 993 patients undergoing coronary angioplasty and 199 (100%) of 199 patients undergoing aortic or mitral valvuloplasty. There were no perforations or significant arrhythmic complications related to pacemaker placement in these 1,033 cases, and pacing was initiated promptly when required by withdrawal of the catheter tip into the right ventricle. Significant bradycardia or new conduction defects developed in 17 patients (1%) during diagnostic catheterization, 10 patients (1%) during angioplasty and 20 patients (10%) during valvuloplasty, but were severe enough to require initiation of temporary pacing in only 1 (0.06%), 4 (0.4%) and 5 (2.5%) patients, respectively. No patient undergoing diagnostic catheterization or angioplasty (but 5 patients undergoing valvuloplasty) required immediate pacing support to treat a life-threatening bradycardia. The total cost of prophylactic pacemakers was $103,300, with a cost per actual use of $19,300 for diagnostic cases, $16,025 for angioplasty and $3,980 for balloon valvuloplasty. These data suggest that prophylactic temporary pacing is not indicated during either diagnostic catheterization or coronary angioplasty, but should be used routinely during balloon valvuloplasty.