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Long B, Bridwell RE, DeVivo A, Gottlieb M. Transvenous Pacemaker Placement: A Review for Emergency Clinicians. J Emerg Med 2024; 66:e492-e502. [PMID: 38453595 DOI: 10.1016/j.jemermed.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Transvenous pacemaker placement is an integral component of therapy for severe dysrhythmias and a core skill in emergency medicine. OBJECTIVE This narrative review provides a focused evaluation of transvenous pacemaker placement in the emergency department setting. DISCUSSION Temporary cardiac pacing can be a life-saving procedure. Indications for pacemaker placement include hemodynamic instability with symptomatic bradycardia secondary to atrioventricular block and sinus node dysfunction; overdrive pacing in unstable tachydysrhythmias, such as torsades de pointes; and failure of transcutaneous pacing. Optimal placement sites include the right internal jugular vein and left subclavian vein. Insertion first includes placement of a central venous catheter. The pacing wire with balloon is then advanced until electromechanical capture is obtained with the pacer in the right ventricle. Ultrasound can be used to guide and confirm lead placement using the subxiphoid or modified subxiphoid approach. The QRS segment will demonstrate ST segment elevation once the pacing wire tip contacts the endocardial wall. If mechanical capture is not achieved with initial placement of the transvenous pacer, the clinician must consider several potential issues and use an approach to evaluating the equipment and correcting any malfunction. Although life-saving in the appropriate patient, complications may occur from central venous access, right heart catheterization, and the pacing wire. CONCLUSIONS An understanding of transvenous pacemaker placement is essential for emergency clinicians.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Anthony DeVivo
- Department of Emergency Medicine, Institute for Critical Care Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University, Chicago, Illinois
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Manoj P, Kim JA, Kim S, Li T, Sewani M, Chelu MG, Li N. Sinus node dysfunction: current understanding and future directions. Am J Physiol Heart Circ Physiol 2023; 324:H259-H278. [PMID: 36563014 PMCID: PMC9886352 DOI: 10.1152/ajpheart.00618.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
The sinoatrial node (SAN) is the primary pacemaker of the heart. Normal SAN function is crucial in maintaining proper cardiac rhythm and contraction. Sinus node dysfunction (SND) is due to abnormalities within the SAN, which can affect the heartbeat frequency, regularity, and the propagation of electrical pulses through the cardiac conduction system. As a result, SND often increases the risk of cardiac arrhythmias. SND is most commonly seen as a disease of the elderly given the role of degenerative fibrosis as well as other age-dependent changes in its pathogenesis. Despite the prevalence of SND, current treatment is limited to pacemaker implantation, which is associated with substantial medical costs and complications. Emerging evidence has identified various genetic abnormalities that can cause SND, shedding light on the molecular underpinnings of SND. Identification of these molecular mechanisms and pathways implicated in the pathogenesis of SND is hoped to identify novel therapeutic targets for the development of more effective therapies for this disease. In this review article, we examine the anatomy of the SAN and the pathophysiology and epidemiology of SND. We then discuss in detail the most common genetic mutations correlated with SND and provide our perspectives on future research and therapeutic opportunities in this field.
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Affiliation(s)
- Pavan Manoj
- School of Public Health, Texas A&M University, College Station, Texas
| | - Jitae A Kim
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Stephanie Kim
- Department of BioSciences, Rice University, Houston, Texas
| | - Tingting Li
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Maham Sewani
- Department of BioSciences, Rice University, Houston, Texas
| | - Mihail G Chelu
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Na Li
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Xiao Z, He J, Yang D, An Y, Li X. Bridge pacemaker with an externalized active fixation lead for pacemaker-dependent patients with device infection. Pacing Clin Electrophysiol 2022; 45:761-767. [PMID: 35357706 DOI: 10.1111/pace.14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of Cardiac Implantable Electronic Device (CIED) infection has been increasing in recent years. For pacemaker-dependent patients, a temporary pacemaker is needed before a new device can be implanted. The aim of this study is to evaluate the safety and efficacy of using a temporary pacing device with an externalized active fixation lead (bridge pacemaker) before a new device can be implanted in pacemaker-dependent patients with device infection. METHODS All patients who were admitted to our cardiac center with CIED infection and in need of bridge pacemaker implantation from April 2013 to August 2020 were prospectively enrolled in this observational study. The medical records of all patients were collected and evaluated. All procedure-related complications were also collected. Long-term outcomes, including reinfection and death within one year after hospital discharge, were collected through telephone follow-ups. RESULTS During the study period, 1,050 patients underwent CIED extraction, of which 312 pacemaker-dependent patients underwent bridge pacemaker implantation. The mean age of the extracted leads was 44±38.7 months. The bridge pacemakers were in use for a mean duration of six days. Nine patients developed procedure-related complications including pericardial tamponade, pneumothorax, peripheral venous thrombosis, and pulmonary embolism. Three patients developed complications that were related to their bridge pacemakers, including lead dislodgement, over-sensing and elevated pacing threshold. During the 1-year follow-up, it was found that four patients had developed CIED reinfection and three patients had died due to cardiac-related reasons. CONCLUSIONS A bridge pacemaker with an externalized active fixation lead is safe and efficacious for pacemaker-dependent patients with device infection. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zengli Xiao
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Jinshan He
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Dandan Yang
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Youzhong An
- Intensive care unit, Peking University People's Hospital, Beijing, China
| | - Xuebin Li
- Cardiovascular department, Peking University People's Hospital, Beijing, China
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Diemberger I, Massaro G, Rossillo A, Chieffo E, Dugo D, Guarracini F, Pellegrino PL, Perna F, Landolina M, De Ponti R, Berisso MZ, Ricci RP, Boriani G. Temporary transvenous cardiac pacing: a survey on current practice. J Cardiovasc Med (Hagerstown) 2021; 21:420-427. [PMID: 32332379 DOI: 10.2459/jcm.0000000000000959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Temporary transvenous cardiac pacing (TTCP) is a standard procedure in current practice, despite limited coverage in consensus guidelines. However, many authors reported several complications associated with TTCP, especially development of infections of cardiac implantable electronic devices (CIED). The aim of this survey was to provide a country-wide picture of current practice regarding TTCP. METHODS Data were collected using an online survey that was administered to members of the Italian Association of Arrhythmology and Cardiac Pacing. RESULTS We collected data from 102 physicians, working in 81 Italian hospitals from 17/21 regions. Our data evidenced that different strategies are adopted in case of acute bradycardia with a tendency to limit TTCP mainly to advanced atrioventricular block. However, some centers reported a greater use in elective procedures. TTCP is usually performed by electrophysiologists or interventional cardiologists and, differently from previous reports, mainly by a femoral approach and with nonfloating catheters. We found high inhomogeneity regarding prevention of infections and thromboembolic complications and in post-TTCP management, associated with different TTCP volumes and a strategy for management of acute bradyarrhythmias. CONCLUSION This survey evidenced a high inhomogeneity in the approaches adopted by Italian cardiologists for TTCP. Further studies are needed to explore if these divergences are associated with different long-term outcomes, especially incidence of CIED-related infections.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S.Orsola-Malpighi University of Bologna, Bologna
| | - Giulia Massaro
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S.Orsola-Malpighi University of Bologna, Bologna
| | | | - Enrico Chieffo
- Institute of Cardiology, Maggiore Hospital, Crema, Italy
| | - Daniela Dugo
- Department of Cardiology and Angiology, Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
| | | | | | - Francesco Perna
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart, Rome
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Circolo e Fondazione Macchi Hospital, Varese
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena University of Modena and Reggio Emilia, Modena, Italy
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Outcomes of emergency department placement of transvenous pacemakers. Am J Emerg Med 2016; 34:1411-4. [PMID: 27133534 DOI: 10.1016/j.ajem.2016.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/29/2016] [Accepted: 04/07/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Placement of TVPs is a core EM procedure. Despite this, there is no specific outcome data on this procedure in the ED setting. This study examines the success of Emergency Physician (EP) attempted TVPs as well as their hospital courses and survivals. METHODS The charts of patients undergoing TVP placement in the ED of an urban community hospital were prospectively collected by a department billing abstractor and then underwent a structured review. All patients had a TVP placed by a board eligible or board certified EP or by a PGY2 EM resident under the direct supervision of an attending EP. All TVPs were placed utilizing a 5 Fr balloon tipped bi-polar pacer without fluoroscopic visualization. RESULTS Over a 36 month period, 43 patients met the study criteria. The mean age was 76.6 (+/- 1.49) years with 27 females (62.7%). Successful pacemaker capture was achieved in 41(95.4%) of TVP attempts. All of the patients were transferred from the ED with vital signs, 41 (95.4%) to a critical care unit and 2 (4.6%) to the electrophysiology laboratory. A total of 26 (60%) patients received permanent pacemakers. Four patients (9.3%) expired during their hospital stay. The remaining patients were discharged to the following: 31 (72%) to home, 5 (11.6%) to a subacute rehabilitation facility, 3 (7%) to a nursing home. CONCLUSION EP placed TVPs have a high rate of successful capture and patients undergoing this procedure have a good prognosis.
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Kossaify A. Temporary Endocavitary Pacemakers and their Use and Misuse: the Least is Better. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:9-11. [PMID: 24453502 PMCID: PMC3891625 DOI: 10.4137/cmc.s13272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 11/11/2013] [Accepted: 11/19/2013] [Indexed: 11/11/2022]
Abstract
Temporary pacemakers are classically indicated for severe bradydysrhythmia, especially when the clinical settings require prompt intervention. Implantation of a temporary pacemaker is not a benign procedure since it may be associated with serious adverse events such as infection, cardiac perforation, and lead dislodgment. Accordingly, we recommend, when the clinical condition allows, to proceed directly with permanent pacemaker implantation without prior use of a temporary pacemaker. However, if a temporary pacemaker is required, it should be maintained for the shortest time possible. This policy allows avoiding or decreasing the potential complications associated with temporary pacemaker implantation.
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Affiliation(s)
- Antoine Kossaify
- Electrophysiology Unit, Cardiology division, USEK-University Hospital Notre Dame de Secours, St Charbel Street, Byblos, Lebanon
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Chowdhry V, Biswal S. Transvenous pacing and manipulation of heart in coronary artery bypass grafting: A word of caution. Indian J Anaesth 2013; 57:204-6. [PMID: 23825829 PMCID: PMC3696277 DOI: 10.4103/0019-5049.111872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Vivek Chowdhry
- Department of Cardiac Anesthesiology and Critical Care, Care Hospital, Bhubaneswar, Odisha, India
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Muñoz Bono J, Prieto Palomino M, Macías Guarasa I, Hernández Sierra B, Jiménez Pérez G, Curiel Balsera E, Quesada García G. Efficacy and safety of non-permanent transvenous pacemaker implantation in an intensive care unit. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.medine.2011.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Muñoz Bono J, Prieto Palomino MA, Macías Guarasa I, Hernández Sierra B, Jiménez Pérez G, Curiel Balsera E, Quesada García G. [Efficacy and safety of non-permanent transvenous pacemaker implantation in an intensive care unit]. Med Intensiva 2011; 35:410-6. [PMID: 21640435 DOI: 10.1016/j.medin.2011.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 04/04/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze the clinical indications for use, morbidity and mortality associated with a non-permanent transvenous pacemaker. DESIGN Prospective and observational study. SETTING Cardiac intensive care unit. METHOD One hundred and eighty-two patients with non-permanent pacemakers implanted consecutively over a period of four years. DATA COLLECTED Main variables of interest were demographic data, clinical indications, access route, length of stay and complications. RESULTS A total of 63% were men, with a median age of 78 ± 9.5 years and with symptomatic third-degree atrioventricular block in 76.9% of the cases. Femoral vein access was preferred in 92.3% of the cases. Complications appeared in 40.11% of the patients, the most frequent being hematoma at the site of vascular access (13.19%). Restlessness was associated to the need for repositioning the pacemaker due to a shift in the electrode (p=0.059) and to hematoma (p=0.07). Subclavian or jugular vein lead insertion (p=0.012; OR=0.16; 95%CI, 0.04-0.66), restlessness during admission to ICU (p=0.006; OR=3.2; 95%CI, 1.4-7.3), and the presence of cardiovascular risk factors (p=0.042; OR=5; 95%CI, 1.06-14.2) were identified by multivariate analysis as being predictors of complications. Length of stay in ICU was significantly longer when lead insertion was carried out by specialized staff (p=0.0001), and in the presence of complications (p=0.05). CONCLUSIONS Predictfurors of complications were restlessness, cardiovascular risk factors, and insertion through the jugular or subclavian vein. Complications prolonged ICU stay and were not related to the professionals involved.
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Affiliation(s)
- J Muñoz Bono
- Servicio de Cuidados Críticos y Urgencias, Hospital Regional Universitario Carlos Haya, Málaga, España.
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Harrigan RA, Chan TC, Moonblatt S, Vilke GM, Ufberg JW. Temporary transvenous pacemaker placement in the Emergency Department. J Emerg Med 2007; 32:105-11. [PMID: 17239740 DOI: 10.1016/j.jemermed.2006.05.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 11/03/2005] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Abstract
Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated. The indications for the procedure, as well as the equipment needed, are reviewed. Both blind and ECG-guided techniques of insertion are described. Methods of verification of pacemaker placement and function are discussed, as are the early complications of the procedure.
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Affiliation(s)
- Richard A Harrigan
- Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
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Braun MU, Rauwolf T, Bock M, Kappert U, Boscheri A, Schnabel A, Strasser RH. Percutaneous lead implantation connected to an external device in stimulation-dependent patients with systemic infection--a prospective and controlled study. Pacing Clin Electrophysiol 2006; 29:875-9. [PMID: 16923004 DOI: 10.1111/j.1540-8159.2006.00454.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Martin U Braun
- Medical Clinic II, Department of Internal Medicine and Cardiology, University of Technology Dresden, Dresden, Germany
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Song FQ, Xie L, Chen MH. Transoesophageal cardiac pacing is effective for cardiopulmonary resuscitation in a rat of asphyxial model. Resuscitation 2006; 69:263-8. [PMID: 16524658 DOI: 10.1016/j.resuscitation.2005.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 08/30/2005] [Accepted: 09/06/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate effectiveness of transoesophageal cardiac pacing in a rat model of asphyxial cardiac arrest. METHODS Ten minutes after the tracheal tube had been clamped, cardiac arrest (CA) occurred in 20 Sprague-Dawley rats, and the rats were assigned randomly to receive cardiopulmonary resuscitation (CPR) in a control group or CPR combined with transoesophageal cardiac pacing in a pacing group. Restoration of spontaneous circulation (ROSC) was defined as an unassisted pulse with a mean arterial pressure (MAP) of >or=20 mmHg for >or=1 min. RESULTS ROSC was significantly more frequent in the pacing group compared with the control group (7/10 versus 1/10, P<0.05). Faster ROSC and longer survival trend in the pacing group were seen compared with the control group. CONCLUSION Transoesophageal cardiac pacing is effective for CPR in a rat of asphyxial model. However, the precise mechanism is not clear and further experiments will be necessary.
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Affiliation(s)
- Feng-Qing Song
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, PR China
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Birkhahn RH, Gaeta TJ, Tloczkowski J, Mundy T, Sharma M, Bove J, Briggs WM. Emergency medicine-trained physicians are proficient in the insertion of transvenous pacemakers. Ann Emerg Med 2004; 43:469-74. [PMID: 15039689 DOI: 10.1016/j.annemergmed.2003.09.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE The insertion and management of a temporary transvenous pacemaker can be a lifesaving procedure in the emergency department setting. We compare the success and complication rates associated with temporary transvenous pacemaker insertion between physicians trained in either emergency medicine or cardiology. METHODS This was a retrospective medical record review of all patients with a billing code for temporary transvenous pacemaker insertion at our institution between July 1999 and December 2002. Patients were excluded if the temporary transvenous pacemaker was not supervised by an attending physician or was placed under fluoroscopy or if the indication for pacing was asystole. Cases were reviewed by 2 physicians certified in emergency medicine and categorized by the specialty training of the attending physician providing direct supervision. RESULTS During the review period, 10 emergency medicine faculty and 8 cardiologists directly supervised 141 of the 158 temporary transvenous pacemaker insertions in 154 patients. Twenty-four were placed for asystole, 4 were placed under fluoroscopy, and 13 were placed without direct attending supervision, leaving a total of 117 cases (30 emergency medicine, 87 cardiology) for review. The procedure was successful 97% (95% confidence interval [CI] 90% to 100%) of the time for emergency medicine faculty and 95% (95% CI 91% to 100%) of the time for cardiology faculty. Complications were seen in 23% (95% CI 7% to 39%) of the temporary transvenous pacemakers inserted by emergency medicine attending physicians and 20% (95% CI 11% to 28%) of the temporary transvenous pacemakers inserted by cardiologists. There was no statistical difference in errors between the specialties, and no complication resulted in death or prolonged disability. CONCLUSION Physicians trained in emergency medicine perform temporary transvenous pacemaker insertions in the acute care setting with a proficiency similar to that of their counterparts in cardiology.
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Affiliation(s)
- Robert H Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA.
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Abstract
Temporary cardiac pacing provides electrical stimulation to a heart compromised by disturbances in the conduction system causing hemodynamic instability. The use of a temporary pacemaker to treat a bradydysrhythmia or in some cases, a tachydysryhthmia, is undertaken when the condition is temporary and a permanent pacemaker is not necessary or available in a timely fashion. Temporary cardiac pacing is utilized in acute situations and for critically ill patient populations requiring immediate therapy. This article discusses the various indications and contraindications to temporary cardiac pacing therapy, reviews the different modalities of temporary pacemakers, and outlines critical considerations in the management of patients being treated with a temporary pacemaker.
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Wald DA. THERAPEUTIC PROCEDURES IN THE EMERGENCY DEPARTMENT PATIENT WITH ACUTE MYOCARDIAL INFARCTION. Emerg Med Clin North Am 2001; 19:451-67. [PMID: 11373989 DOI: 10.1016/s0733-8627(05)70194-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Life-threatening cardiac arrhythmias and other peri-infarct complications are often unexpected and commonly present with little warning. The therapeutic procedures reviewed often require immediate implementation and should be second nature to any physician involved in the management of patients with an AMI.
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Affiliation(s)
- D A Wald
- Division of Emergency Medicine, Department of Internal Medicine, Temple University Hospital and School of Medicine, Philadelphia, Pennsylvania, USA
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Laczika K, Thalhammer F, Locker G, Apsner R, Losert H, Kofler J, Rabitsch W, Mares P, Frass M, Sunder-Plassmann G, Muhm M. Safe and Efficient Emergency Transvenous Ventricular Pacing via the Right Supraclavicular Route. Anesth Analg 2000. [DOI: 10.1213/00000539-200004000-00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Laczika K, Thalhammer F, Locker G, Apsner R, Losert H, Kofler J, Rabitsch W, Mares P, Frass M, Sunder-Plassmann G, Muhm M. Safe and efficient emergency transvenous ventricular pacing via the right supraclavicular route. Anesth Analg 2000; 90:784-9. [PMID: 10735776 DOI: 10.1097/00000539-200004000-00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Infraclavicular and internal jugular central venous access are techniques commonly used for temporary transvenous pacing. However, the procedure still has a considerable complication rate, with a high risk/benefit ratio because of insertion difficulties and pacemaker malfunction. To enlarge the spectrum of alternative access sites, we prospectively evaluated the right supraclavicular route to the subclavian/innominate vein for emergency ventricular pacing with a transvenous flow-directed pacemaker as a bedside procedure. For 19 mo, 17 consecutive patients with symptomatic bradycardia, cardiac arrest, or torsade de pointes requiring immediate bedside transvenous pacing were enrolled in the study. The success rate, insertional complications, pacemaker performance, and patients' outcomes were recorded. Supraclavicular venipuncture was successful in all patients, in 16 of 17 at the first attempt. Adequate ventricular pacing was achieved within 1 to 5 min (median, 2 min) after venipuncture and within 10 s to 4 min (median, 30 s) after lead insertion (</=30 s in 15 of 17 patients). The median pacing threshold was 1 mA (range, 0.7 to 2.5 mA). No procedure-related complications were recorded. Throughout the pacing period of 1538 h (median: 62 h, range, 1-280 h) two reversible malfunctions caused by inadvertent lead dislodgement after 122 and 171 h were recorded; in one patient the pacemaker had to be removed because of local infection after 14 days of pacing. We conclude that the right supraclavicular route is an easy, safe, and effective first approach for transvenous ventricular pacing and might provide a useful alternative to traditional puncture sites, even in a preclinical setting. IMPLICATIONS Temporary transvenous cardiac pacing can yield high complication rates especially under emergency conditions. We investigated emergency pacing via the right supraclavicular access in 17 consecutive hemodynamically compromised patients and found good safety, efficacy, and a low complication rate.
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Affiliation(s)
- K Laczika
- Departments of Internal Medicine I, Division of Intensive Care, Vienna University Hospital, Vienna, Austria.
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