Abstract
Temporary cardiac pacing is commonly used in patients with life-threatening bradycardia and serves as a bridge to implantation of a permanent pacemaker (PPM). For years, passive fixation leads have been used for this purpose, offering the advantage of that they can be placed at bedside. The downside, however, is that patients must remain on telemetry and bed rest until lead removal due to the risk of displacement and failure to capture. Even then, the latter cannot always be prevented. Temporary cardiac pacing with passive fixation leads has also been related to a higher incidence of infection and venous thrombosis, delayed recovery, and increased length of stay. Thus, over the last couple of decades, pacemaker leads with an active fixation mechanism have become increasingly used. This is known as a temporary PPM (TPPM) approach, which carries a very low risk of lead dislodgement and allows patients to ambulate, among other advantages. Here, we performed a review of the literature on the use of TPPMs and their advantages over temporary pacemakers with passive fixation leads and in order to evaluate the advantages and disadvantages of active and passive fixation leads in temporary cardiac pacing. Most articles found were case reports and case series, with few prospective studies. We excluded documents such as editorials and image case reports that provided little to no useful information for the final analysis. The literature search was performed in PubMed, Google Scholar, and other databases and articles written in English and Spanish were considered. Articles were screened up to January 2017. The search keywords used were “temporary permanent pacemaker,” “external permanent pacemaker,” “active fixation lead,” “explantable pacemaker,” “hybrid pacing,” “temporary permanent generator,” “prolonged temporary transvenous pacing,” and “semipermanent pacemaker.” A total of 24 studies with 770 patients were ultimately included in our review. The age group was primarily above the sixth decade of life, with the exception of one that included pediatric patients. Indications for pacing included device infection, sick sinus syndrome, atrioventricular block, ventricular tachycardia, and bradyarrhythmias associated with systemic illness. The duration of TPPM usage varied from a few days up to 336 days. A total of 18 (2.3%) TPPM-related infections were reported, in which the duration of TPPM use was less than 30 days in at least 15 patients. Loss of capture was documented in only eight patients (1.0%). Complication rates varied from 0% to 30%, with the highest event rates being present in studies that used femoral venous access. In conclusion, although no high-quality studies were identified in our literature search, we found the data retrieved suggest the association of overall favorable outcomes with the use of TPPMs. Device placement and removal typically involve a simple procedure, although fluoroscopy, usually applied in the cardiac catheterization laboratory, is necessary for implantation, which could represent an additional risk in a patient who is already hemodynamically unstable. When possible, a screw-in-lead pacemaker should be used for temporary pacing.
Highlights
Initial descriptions of pulsed electrical stimulation to the heart can be attributed to J
We aimed to determine the advantages and disadvantages of employing temporary permanent pacemakers (PPMs) (TPPM) with active fixation leads versus standard temporary pacing
We found eight patients in the TPPM group were affected, which corresponds to 1.7% of the total number of patients (Table 3)
Summary
Initial descriptions of pulsed electrical stimulation to the heart can be attributed to J. A. McWilliam in the late 19th century.[1] Subsequently, the first pacemaker device was built by the American physiologist Albert Hyman in 1932. In 1952, Drs John Callaghan and Wilfred Bigelow and engineer Jack Hopps developed a bipolar catheter able to provide endocardial stimulation. Zoll Medical Corporation (Chelmsford, MA, USA) later developed an external pacing system with cutaneous electrodes. In 1959, Seymour Furman and John Schwedel were able to provide endocardial stimulation by utilizing a lead inserted through the internal jugular vein. The first attempts to employ an implantable pacemaker were performed in Sweden in 1958.1 Most publications only refer to Furman when addressing the history of pacemakers
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