Accurate placement of the right atrial air aspiration catheter: A descriptive study and prospective trial of intravascular electrocardiography

Appropriate positioning of the right atrial air aspiration catheter is critical to successful aspiration of air. The intravascular electrocardiography patterns currently used to position the right atrial air aspiration catheter have not been validated by echocardiography. In 10 patients, using simultaneous transesophageal echocardiography and intravascular electrocardiography, we found that the largest monophasic P wave without a biphasic component correlated with the right atrial-superior vena cava junction. Using this pattern, we performed a prospective trial on 10 subjects and demonstrated appropriate positioning in only 8. This preliminary study suggests that intravascular electrocardiography may not yield appropriate positioning in all patients.