Transjugular temporary pacing through a radial sheath in inferior STEMI with complete atrioventricular block and cardiogenic shock: A technical case report

Abstract

Background: Often complicated by unstable hemodynamics and cardiac conduction disorders, late-presenting inferior ST-segment elevation myocardial infarction (STEMI) with concomitant right ventricular involvement requires specialized management. These patients typically require temporary transvenous pacing. However, the feasibility of using a radial sheath as an introducer for transjugular temporary pacing, particularly in critically ill patients, has been insufficiently reported. Case Presentations: This case presents a 58-year-old man with type 2 diabetes mellitus (DM) admitted with inferior STEMI, right ventricular compromise, total atrioventricular block, and cardiogenic shock more than 48 hours after symptom onset. Prior to the definitive culprit-only percutaneous coronary intervention by implanting two drug-eluting stents in the proximal right coronary artery, we established temporary transvenous pacing via the right internal jugular vein using a 6F radial sheath. The procedure was accompanied by residual slow-flow phenomenon and a persistent atrioventricular block despite hemodynamic stabilization, prompting consideration of permanent pacemaker insertion. Conclusions: In hemodynamically unstable inferior STEMI with a complete atrioventricular block, radial sheath-assisted transjugular temporary pacing was a feasible bridging technique prior to and during coronary revascularization. This approach may facilitate transjugular temporary pacing when standard pacing introducers are unavailable. Keyword : Cardiogenic Shock; Inferior STEMI; Temporary Transvenous Pacing; Total Atrioventricular Block; Transjugular Radial Sheath.