Abstract 16716: Clinical Parameters Associated With Temporary Transvenous Pacing for Patients Presenting With Complete Heart Block

Abstract

Introduction: Patients presenting with Complete Heart Block (CHB) are emergently referred for placement of a temporary transvenous pacemaker (TTVP) for hemodynamic stability. Data on the immediate management and outcomes of such patients are lacking. Methods: Data collected through retrospective chart review of patients presenting to the Emergency Department (ED) at 3 regional referral hospitals from 10/2017 to 9/2022 with a diagnosis of new CHB; included age, sex, clinical, laboratory and ECG data, medications, interventions and length of stay(LOS). Results: There were 230 patients (106 women), mean age 77 years. Of these 94 were on beta blockers, 55 on calcium channel blockers. Syncope, dizziness and dyspnea were common symptoms. Pause > 3 seconds was seen in 50 patients. Sympathomimetics were used in 55 patients and 179 patients were admitted to the ICU. There was no statistical difference in demographics, clinical features, ICU utilization and LOS. A TTVP was placed in 72(31%) and a Permanent Pacemaker (PPM) prior to discharge in 182 patients, a median of 1 day from ED presentation. By site, there were 71, 74 and 85 patients of whom TTVP was placed in 38%, 15% and 40% and a PPM in 76%, 82% and 79% in the 3 regional centers. The median LOS was 3 days. Univariate logistic regression was used to assess for predictors of TTVP placement (SAS® Version 9.4, Cary, NC). Syncope, Initial SBP, Shock, Pause > 3 seconds, Acute MI, and Serum K were associated with higher odds of patients getting TTVP. SBP > 160mmHg was associated with lower odds of needing TTVP. Conclusions: TTVP was infrequently needed (31%) among patients presenting to the ED with CHB. Initial SBP, Shock, Acute MI, Pause > 3sec and Serum K were associated with TTVP placement. Higher SBP was associated with lower odds of needing a TTVP. There seems to be a difference in TTVP utilization rate between centers. Prospective data related to the acute management of CHB is needed to identify variations in utilization of TTVP between centers.