Temporary transvenous pacemaker placement: what criteria constitute an adequate pacing site?

Myocardial Injury After Temporary Transvenous Cardiac Pacing

INTRODUCTION

Temporary transvenous cardiac pacing (TTCP) can lead to potential penetration and occasional perforation of the right ventricular wall. No study to date has analyzed the effect of TTCP on myocardial injury by cardiac troponin (cTn) measurement. The present study was designed to investigate perioperative myocardial injury in elective TTCP in noncardiac surgical settings.

PATIENTS AND METHODS

This retrospective study investigated the data collected from August 2018 through March 2020 from 22 eligible patients who underwent elective TTCP for noncardiac procedures. The patients had a median age of 66 (50-83) years; six (27.3%) of them were women, and all of them had a baseline cTn <1 upper reference limit (URL). Cardiac biomarker assays were performed before and after TTCP, and their results were compared.

RESULTS

After TTCP, cTn > 1 URL was detected in 20 (91%, N=22) patients. Among these 22 patients, paired t-test comparing assay results before and after TTCP lead insertion showed a mean cTn elevation of 3.599 URL (95% CI: 1.566 to 5.632, P<0.01), and a mean creatine kinase-MB isoform elevation of 0.1550 URL (95% CI: -0.01239 to 0.3224, P>0.05).

CONCLUSION

The study demonstrates a high incidence of myocardial injury associated with TTCP, which should be a matter of concern for the involved physicians.

Bedside temporary transvenous cardiac pacemaker placement

Temporary transvenous cardiac pacing is a life-saving procedure in an emergency. Transvenous cardiac pacing catheterization guided by intracavitary electrocardiogram (IC-ECG), instead of fluoroscope, is practical. Tips for controlling the orientation of the pacing catheter tip and utilizing IC-ECG to monitor the positions of electrodes make bedside temporary transvenous cardiac pacing catheter placement feasible and 'visible'. The technique discussed here is comparable to the operation under fluoroscopy，but without exposure to X-ray.

Temporary Cardiac Pacing in the Intensive Care Unit

Indications for temporary cardiac pacing have increased substantially in the last several years. Although most temporary cardiac pacing is still carried out to treat symptomatic bradycardia due to atrioventricular conduction system disease or atrial bradycardia (i.e., sinus node dysfunction), temporary pacing is currently used to induce and to terminate some supraventricular tachyarrhythmias, prevent pause-dependent ventricular tachycardia (usually torsades de pointes), and vagally mediated atrial fibrillation, to allow the maintenance of hemodynamic competence in postoperative cardiac patients and to evaluate selected patients with hypertrophic and dilated cardiomyopathies who might benefit hemodynamically from cardiac pacing. The roles of transcutaneous and esophageal pacing have also expanded; transcutaneous pacing is now commonly used in patients at high risk for the development of atrioventricular block, such as those with acute myocardial infarction and bifascicular block. We review available types of temporary pacing leads and pulse generators, the methods by which temporary pacing is accomplished, complications of pacing system insertion, and current indications for this therapy. Guidelines for troubleshooting normal and abnormal pacemaker function in the intensive care unit setting are provided.