Anesth Analg 2007;104:743
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000255968.34562.09
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Don’t Abandon Martin’s Intravascular Electrocardiography Technique!
Randall Kerr, MD, and
Richard Applegate, II, MD
Department of Anesthesiology; Loma Linda University Medical Center; Loma Linda, California; kerr.randall{at}gmail.com
In Response:
We appreciate Dr. Johan’s (1) comments on our work concerning positioning the right atrial air aspiration catheter using intravascular electrocardiogram (ECG). (2) We were not suggesting that Martin’s method be abandoned. We chose to transduce the J-wire because that method yields a superior signal to noise ratio (3) and is most frequently used at our facility. Matin’s method, as Dr. Johans correctly points out, has the advantage of continuous intravascular ECG monitoring.
Our study showed that the largest monophasic p wave without a biphasic component is the J-wire intravascular ECG pattern that usually correlates with the transesophageal echocardiography-determined junction of the right atrium and the superior vena cava. However, it also revealed that anatomic or electrical variations of the atria may lead to poor catheter positioning.
Intravascular ECG-guided positioning relies on the functional SA node being located at the junction of the right atrium and the superior vena cava. Boineau et al. (4) showed that the location of the atrial pacemaker varies routinely over an area of 7.5 cm by 1.5 cm and occasionally much further.
Whether one transduces using a J-wire or an electrolyte solution, we believe that transesophageal echocardiography is a useful adjunct for procedures with high risk of air embolism: both for catheter positioning and for presurgical screening for cardiac abnormalities such as septal defects (5–8).
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