Clinical competence in insertion of a temporary transvenous ventricular pacemaker. ACP/ACC/AHA Task Force on Clinical Privileges in Cardiology

Epicardial pacemaker as a bridge for pacemaker-dependent patients undergoing explantation of infected cardiac implantable electronic devices

BACKGROUND AND AIM OF THE STUDY

Cardiac implantable electronic device (CIED) implantation is associated with an increase in CIED infection. For pacemaker-dependent patients, temporary pacemaker leads are implanted until infection remission, which allows new CIED implantation. We compared the outcome of pacemaker-dependent patients with infected CIED based on whether a combined single procedure of epicardial pacemaker implantation with system extraction or a temporary transjugular pacemaker implantation with interval system implantation was performed.

METHODS

This retrospective study included pacemaker-dependent patients with CIED infection who were divided into two groups: the Tempo and Epi groups. The Tempo group received temporary transvenous pacemaker connected to an external pulse generator. After infection remission, a new permanent pacemaker was implanted, and the temporary pacemaker leads were removed. The Epi group received implantable epicardial right-ventricular pacemaker through infrasternal inferior pericardiotomy, and a permanent pulse generator was implanted through the same incision between the subcutaneous tissue and abdominal fascia.

RESULTS

Sixty-six patients were included. Forty-two patients with epicardial pacemakers were discharged after 9.5 ± 8.8 days without infection of the newly implanted epicardial pacemaker. Patients with temporary transjugular pacemaker lead were discharged 23 ± 15 days after receiving permanent pacemakers. No serious complications were recorded in the Epi group.

CONCLUSIONS

CIED infections in pacemaker-dependent patients can be treated through epicardial pacemaker implantation that allows early patient mobility and reduces hospital stay with no risk of epicardial pacemaker infection. Epicardial pacemakers can be used as a bridge until permanent intravenous CIED is implanted or as a replacement for permeant intravenous CIED.

Temporary cardiac pacemaker treatment in five Norwegian regional hospitals

OBJECTIVES

Over the last few decades the number of temporary pacemaker placements has declined, while the number of operators has increased. The present study was undertaken in order to assess the quality of present day temporary pacing in Norwegian general hospitals.

DESIGN

Prospective, multi-center study from five general hospitals in Norway with a catchment area of 998,000 inhabitants. All temporary pacing procedures performed at these hospitals during a 1-year period should be registered.

RESULTS

Fifty patients were treated with temporary pacing and six repeated procedures were performed due to pacing failure. The yearly procedure-rate was five per 100,000 inhabitants. Twenty-nine physicians were involved in these procedures, of whom five were experienced implanters, and 18 physicians participated in only one procedure each. Following temporary pacing a permanent pacemaker was implanted in 60% of patients. In-hospital mortality was 18%, and the incidence of bacteremia was 6%.

CONCLUSIONS

Temporary pacemaker treatment is currently performed with less than the required amount of skill, with a high number of complications. Cardiologists on call and the possibility of fast-track permanent implantation could improve the quality of care of patients with acute bradyarrhythmias.

Ten years on: has competence and training in temporary transvenous cardiac pacing improved?

Ten years ago in the pre-Calman era, Davis and Roberts (1996) examined the practice of temporary cardiac pacing in north-west England. Now, in the post-Calman and Modernising Medical Careers era, a new survey has found no improvement in this important practice.

Percutaneous lead implantation connected to an external device in stimulation-dependent patients with systemic infection--a prospective and controlled study

BACKGROUND

Permanent pacemaker implantation usually is contraindicated in patients with systemic infection. The aim of the present study was to compare two different techniques of transvenous temporary pacing to bridge the infectious situation until permanent pacemaker implantation under infection-free conditions is possible.

METHODS AND RESULTS

Forty-nine patients with systemic infection and hemodynamic-relevant bradyarrhythmia/asystole were temporarily paced using either a conventional pacing wire/catheter (n = 26, reference group) or a permanent bipolar active pacing lead, which was placed transcutaneously in the right ventricle and connected to an external pacing generator (n = 23, external lead group). In both groups, there were no significant differences in patient characteristics. Whereas the sensing values were almost identical, the median pacing threshold was significantly higher in the reference group (1.0 V vs 0.6 V, P < 0.05). Within comparable duration of pacing (median: 8.2 vs 7.7 days), there were 24 pacing-related adverse events (including dislocation, resuscitation due to severe bradycardia, or local infection) in the reference group as compared to one event in the external lead group (P < 0.01). None of these complications resulted in cardiac death.

CONCLUSION

Thus, transvenous pacing with active fixation is safe and associated with a significantly lower rate of pacing-related adverse events as compared to the standard technique of transvenous pacing using a passive external pacing catheter.