Arrhythmias are common in the critically ill patient and can result from a wide variety of physiologic disturbances. As the potential etiologies are many (intrinsic heart disease, myocardial ischemia, electrolyte abnormalities, hypoxemia, acidosis, volume alterations, endocrine irregularities, and others), it is difficult to pinpoint the underlying pathology in most cases. However, one should certainly not overlook the role that vascular catheters play in new-onset arrhythmias. In particular, pulmonary artery catheters have a high risk of inciting both atrial and ventricular arrhythmias, and removal of the line should be strongly considered.

The incidence of arrhythmias related to pulmonary artery catheterization is best described during initial catheter insertion. Premature atrial and ventricular contractions are frequent while advancing the catheter and have been reported in 13% to 87% of patients. More concerning disturbances, such as nonsustained ventricular tachycardia and right bundle branch blocks, are also common; however, these arrhythmias are usually well tolerated. Ventricular tachycardia, ventricular fibrillation, and complete heart block, on the other hand, require emergent intervention. Fortunately, these unstable arrhythmias occur in less than 1% of all catheterizations.