Lehman K. Preis’s research while affiliated with University of Virginia and other places

The medical records of 100 patients who received 113 temporary transvenous pacemakers were reviewed to determine the incidence of complications and malfunction. Malfunction, defined as failure to capture or sense, or both, occurred in 42 (37 percent) of 113 temporary pacemakers. The initial malfunction occurred within 24 hours in 21 (50 percent) and within 48 hours in 36 (86 percent) of the 42 pacemakers. Although the incidence of malfunction was not significantly different for brachial and femoral venous pacing catheters, 7 (37 percent) of 19 brachial venous pacemakers required repositioning or replacement compared with 8 (9 percent) of 91 femoral venous catheters (p = 0.005). Thirty-seven complications occurred in 23 (20 percent) of 113 episodes of pacing; ventricular tachycardia during catheter insertion, fever and phlebitis were the most common complications. No complication resulted in death. The incidence of complications and perforation was greater for brachial than for femoral venous pacemakers (p less than 0.05). Sepsis, local infection and pulmonary embolus occurred only with femoral venous pacemakers. Sepsis, phlebitis and pulmonary embolus were more common with temporary pacemakers in place for 7 hours or longer (p = 0.04). Recognition to the problems peculiar to each pacing catheter site and shortening the duration of pacing should help minimize problems with temporary pacing.

Small intracavitary echoes are often visualized in the right atrium and right ventricle following the intravenous injection of various agents such as saline, dextrose in water, or indocyanine green dye. Occasionally, these microbubbles can be seen within the left atrium or left ventricle when there is a right-to-left shunt at the atrial or ventricular level. The etiology of these echoes has been attributed to visualization of microcavitation or microbubbles formed from dissolved gasses in the intravenous solution [1–3]. However, spontaneous microbubbles are rarely seen in the left heart. One theory of the genesis of these spontaneous left ventricular microbubbles is the release of gasses from red blood cells during hemolysis [4].