Temporary Pacing with an Active-Fixation Permanent Bipolar Pacing Lead as an Emergency Treatment of Acute AV-Block

Abstract

Management of patients with systemic infections and concurrent need for acute pacing due to new-onset of hemodynamic relevant bradycardia such as at high grade AV-block is very difficult. Implantation of a permanent pacemaker is contraindicated in the case of ongoing sepsis. As a bridging therapy temporary pacing is needed in patients with life-threatening bradycardias. The complication rate of a temporary pacing like dislodgement of the pacing wire increases significantly in a time-dependent fashion. Therefore, in cases requiring long-term antibiotic treatment such as endocarditis, a different approach might be considered. We have treated two patients with acute infective endocarditis and new onset of hemodynamically relevant bradycardia with a temporary permanent active-fixation bipolar pacing lead connected to a second-hand disinfected pacemaker in VVI mode. In addition, we provide an overview of other published cases. The use of active-fixation permanent pacing leads connected to an externalized pacemaker for temporary pacing in patients requiring intermediate to long-term antibiotic treatment provides a safe and effective method for prolonged temporary pacing as a bridge to permanent pacing or recovery.