1. Coronary stent immobilisation with rapid ventricular pacing technique via coronary guidewire in non-ST elevation myocardial infarction
Dr Zaid Iskandar
Cardiology Speciality Registrar
Ninewells Hospital, Dundee, UK

2. Potential conflicts of interest
Speaker's name: Zaid Iskandar
Travel, accommodation and conference expenses sponsored by Biosensors.

3. History 69 years old male. CABG 1992 – SVG to right coronary artery.
Balloon angioplasty to intermediate artery following acute coronary syndrome
Current smoker.
Previous transient ischaemic attack.
Represented with NSTEMI.
Echo shows normal left ventricular systolic function.

4. Angiography SVG to right coronary artery was patent with good run-off.
Culprit vessel is the intermediate artery.
Intermediate artery successfully wired (Sion Blue, Asahi®) and lesion pre-dilated with a 2.5 x 15 mm compliant balloon (Maverick, Boston Scientific®) to 12 atmospheres.
However stent positioning proved difficult due to movement with the cardiac contractions.

5. Stent immobilisation
Decision made to pace via coronary guidewire to achieve stability in stent positioning.
21 gauge green needle placed into the skin next to radial sheath.
Temporary pacing external clips connected to guidewire (black clip) and 21 gauge needle (red clip).
Guidewire acts as a negative electrode and the skin as a positive electrode.
The ventricle was paced at 5 Volts initially and rate increased to 150 beats/minute once stable capture was observed for 10 to 15 seconds.

6. Lasa et al. Rev Esp Cardiol. 2009;62(3):288-92

7. Stent immobilisation
Drug-eluting stent successfully positioned and deployed (2.75 x 23 mm Xience V, Abbott Vascular®) at 14 atmospheres.
Post-dilated with 3.25 x 15 mm non-compliant balloon at 20 atmospheres.
Good angiographic result.

8. Pacing via coronary guidewire
Previously described technique in literature to aid in coronary stent positioning.
Useful when cardiac contractions cause excessive movement of stent during deployment.

9. Follow-up Patient well at 24 months with no recurrence of angina.
Appropriate secondary prevention measures and engaging with cardiac rehabilitation service.
Discharged from routine clinic follow-up.

10. Conclusions
Ventricular pacing via coronary guidewire is a simple, safe and effective method for coronary stent immobilisation in cases where stent positioning is affected by excessive movement from cardiac contractions.