Application of active-fixation lead for protective temporary pacing during pacemaker implantation

Abstract

Objective This study aimed to investigate the feasibility and safety of active-fixation lead for protective temporary cardiac pacing during permanent pacemaker implantation. Methods We retrospectively enrolled 90 severe complete atrioventricular block patients who needed protective temporary pacing during pacemaker implantation from September 2016 to March 2019 in Fuwai Hospital, and patients were classified into 2 groups by protective temporary cardiac pacing strategies. Patients in group A (n=40) received routine temporary pacing through right femoral venous access, and the temporary pacing lead was removed after permanent pacemaker implantation procedure. Patients in group B (n=50) firstly received temporary cardiac pacing by using an active-fixation lead through venous access (axillary or subclavian vein) during routine procedure of permanent pacemaker implantation. After fixation of ventricular lead for permanent ventricular pacing, the first temporary pacing lead was withdrawn and placed for atrial permanent pacing. The total procedural time, perioperative complications, and X ray exposure were compared between the two groups. Results Patients in two groups had similar baseline clinical characteristics. The frequency of patients needing temporary pacing during procedure was comparable between two groups (83% vs. 84%, P=0.535) . The average time of total procedure in group B was significantly shorter than that in group A (69 min vs.81 min, P=0.011) . The exposure time (3.2 min vs. 7.1 min, P=0.000) and the exposure doses of X ray (2.1 mGy vs.3.3 mGy, P=0.029) were significantly reduced in group B as compared with group A. Two cases had hematomas at puncture site of femoral vein and one case had arteriovenous fistula in group A. No perioperative complications were detected in group B. Temporary pacing lead and delivery sheath used in group A increased additional cost as compared to group B. Conclusion Application of active-fixation lead as temporary pacing lead during permanent pacemaker implantation might be a novel approach with improved cost effectiveness reduced time of procedure, and X-ray exposure instead of routine temporary pacing via femoral venous access. Key words: Pacemaker, artificial; Active-fixation lead; Temporary cardiac pacing