Ventricular fibrillation complicating pacemaker insertion in acute myocardial infarction

Temporary transvenous pacing catheters were placed in 101 patients with acute myocardial infarction (Ml) for the management of bradyarrhythmias or conduction disturbances. Fourteen (14%) patients (group A) developed ventricular fibrillation (VF) at the time of pacing catheter manipulation in the right ventricle. Compared to the remaining 87 (86%) patients (group B), the patients in group A were younger (56.1 vs 65.8 yrs, P = 0.007). Thirteen (92.8%) of 14 patients in group A had inferior MI compared to 58 (66.6%) of 87 patients in group B (P = 0.04). All but one patient in group A had pacemaker insertion within 24 h of the onset of symptoms of Ml compared to 55 (63%) of 87 in group B (P = 0.02). In 12 of the 14 patients in group A, following defibrillation and intravenous bolus administration of lidocaine, the pacing catheter was positioned in the right ventricle without further episodes of VF. It is concluded that (1) in patients with acute MI temporary transvenous pacemaker insertion may be complicated by VF; (2) VF is most likely to occur in younger patients with inferior MI infarction when the pacing catheter is inserted within 24 h of the onset of symptoms of infarction; and (3) administration of an intravenous bolus of lidocaine may be effective in preventing the induction of VF by catheter manipulation.