Abstract
Introduction: the necessity for a temporary pacemaker (TP) goes through several scenarios. Some patients require the device to complete an infection treatment, regain the pace after myocardial infarction, or while awaiting the release of the definitive device by the health care provider. Regardless of the TP passage technique, good electrode fixation is essential, avoiding dislocation and the necessity for repositioning, among other complications. Objective: to compare two forms of TP fixation, one under direct fixation to the skin and the other keeping the venous introducer connected to the plastic protection through the pacemaker electrode lead. Methods: Forty patients were randomized, 20 in each group. Data regarding the procedure time, electrode lead position, command thresholds, sensitivity, and complications were recorded. The primary outcome considered was the necessity for repositioning or exchange of transvenous TP and secondary any complication without the necessity to reposition it. Results: There were no significant differences in the total duration of the procedure between the groups in the initial position of the electrode and the access route used. The group with plastic protection had a higher primary outcome (60%) than the direct fixation group (20%; p = 0.0098). There were no differences regarding the secondary outcome (p = 1.0). The group with plastic protection also had more total complications compared to the other group (p = 0.0262). Conclusion: Direct fixation of the pacemaker electrode lead was safer concerning the fixation with plastic protection, reducing complications such as electrode dislocation requiring repositioning or replacement without increasing the procedure time.
Highlights
METHODSThe necessity for a definitive pacemaker goes through several scenarios, and some patients need to remain under the use of a temporary pacemaker (TP) either to complete an infection treatment, regain the pace after myocardial infarction or even awaiting the release of the definitive device by the health care provider.The rate of pacemaker implantation per million inhabitants in Brazil is substantially lower than in neighboring countries, despite the progressive increase in total implantation of these devices in the last decade1
Even having the preference for passing TP under direct hemodynamic view, there were no significant differences between the groups regarding the mode of TP passage
The present study revealed that patients who had TP fixed directly to the skin had a lower primary outcome, that is, any complication that resulted in the replacement or repositioning of the electrode lead compared to the group that had TP fixed with the plastic protection set and vascular introducer
Summary
METHODSThe necessity for a definitive pacemaker goes through several scenarios, and some patients need to remain under the use of a temporary pacemaker (TP) either to complete an infection treatment, regain the pace after myocardial infarction or even awaiting the release of the definitive device by the health care provider.The rate of pacemaker implantation per million inhabitants in Brazil is substantially lower than in neighboring countries, despite the progressive increase in total implantation of these devices in the last decade. Population aging and the consequent degenerative diseases of the heart excito-conductor system will increase the demand for implantation of these devices shortly.The current economic crisis and chronic underfunding of the Unified Health System (UHS), in contrast, will hinder meeting this growing demand. This scenario will culminate in a more significant number of patients admitted to emergency services awaiting electronic heart device implantation. Many of these patients stay in the hospital for days, weeks, and even months, mostly on transvenous TP. Implantation techniques of these systems in a practical way, ensuring safe ventricular stimulation and avoiding future complications, are essential
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