Intracardiac Pacing of Electrographs Via CVP Line

To the Editor.—  Postoperatively, the patient who has had open-heart surgery is prone to arrhythmias, intraventricular conduction defects, and heart block. A precise evaluation of certain arrhythmias can be difficult or impossible. Recordings from epicardial ventricular pacing wires are not helpful in analyzing the atrial mechanism, and the use of esophageal leads is unpleasant and subject to artifact. Veins are often at a premium, but central venous pressure lines are generally in place in or near the superior vena cava. A 240-gauge polyethylene catheter (internal diameter 0.066 inches) will easily admit a 4F semifloating pacemaking catheter. Using sterile precautions and a doubleended wire connector to the V lead of a properly grounded electrocardiographic machine, an intra-atrial and usually an intraventricular electrograph can be obtained within a minute or two.Atrial flutter was readily diagnosed in a patient postoperatively, with a ventricular rate of 140 beats per minute showing a left