Case report

A 71 year old woman presented with irregular palpitations. Resting 12 lead electrocardiogram showed sinus rhythm at 95 beats per minute, first degree heart block (PR interval 360 ms), left axis deviation, and anteroseptal Q waves suggestive of a previous myocardial infarction. These results were similar to those seen in an electrocardiogram performed in 1991.

Asymptomatic episodes of complete atrioventricular block, frequent ventricular extrasystoles, and infrequent episodes of non-sustained ventricular tachycardia were found on Holter monitoring. She was admitted to hospital to await transfer for insertion of a pacemaker. An Arrowset 8.5 French gauge Swan-Ganz introducer (Arrow International, Reading, PA) was inserted into the right subclavian vein, and a 6 French gauge temporary pacing wire was passed through it. A chest radiograph taken after insertion was normal.

During the first 24 hours after insertion amiodarone hydrochloride 1325 mg was given through the side arm of the subclavian catheter followed by 200 mg orally daily thereafter for 5 days. Displacement of the pacing wire twice in one night occurred 6 days after insertion and necessitated repositioning. A stable paced rhythm of 80 beats per minute was achieved, but she developed clinical and radiographic evidence of pulmonary oedema within 4 hours of the pacing wire being repositioned. Repeated doses of diuretics were given intravenously over 6 hours but did not relieve the patient's symptoms. Because her condition continued to deteriorate, she was …