Indications For Temporary Pacing Research Articles

Outcomes of temporary pacing using active fixation leads and externalized permanent pacemakers in patients with cardiovascular implantable electronic device infection and pacemaker dependency

The incidence of cardiac implantable electronic device (CIED) infections is increasing. Complete device and lead removal are recommended for all patients with definite CIED system infection. In patients with pacemaker dependency, temporary pacing before reimplantation is necessary. In this study, temporary pacing using active fixation leads (TPAFL) was evaluated. We reviewed data from consecutive patients implanted with TPAFL after transvenous lead extraction at our center between November 2014 and October 2020. TPAFL were placed in 334 patients. The mean age was 64.5 ± 16.4 years and 76.3% were males. Two hundred and forty (72%) were treated due to local pocket infection and 94 (28%) systemic infection. The indication for temporary pacing was sick sinus syndrome in 135 (40.4%) patients and complete or high-grade atrioventricular (AV) block in 199 (59.6%) patients. The most common access site for lead implantation was the ipsilateral subclavian or axillary vein (78.9%). A new permanent CIED was reimplanted at 10.3 ± 9.2 days (median 10, range: 2-70) after implantation of the temporary pacing. There were five (1.5%) adverse events related to the temporary pacing during hospitalization. The median follow-up duration was 23.1 months (interquartile range [IQR], 7.2-43.4 months). Only one patient (0.3%) developed recurrent CIED infection. TPAFL is safe and effective in pacemaker-dependent patients after infected CIED removal. The rate of temporary pacing-related complications, including lead dislodgment and reinfection of CIED is relatively low.

Long-term temporary pacing with an active fixation lead.

Ensuring a haemodynamically effective cardiac rhythm is a challenge in patients waiting for pacemaker reimplantation after transcutaneous lead extraction due to an infection of the implanted system. The authors report a retrospective analysis of temporary pacing with an active fixation lead (AFTP) connected to an externalised pacemaker in patients after transvenous lead extraction (TLE) due to an infection. AFTP was used in 34 patients (12 women) aged from 38 to 88 years (mean 67.5 years). This represented 24.5% of the population of patients undergoing TLE due to infective indications. In 32 cases, the indication for temporary pacing was atrioventricular block, and in 2 patients sick sinus syndrome. The lead was implanted via the internal jugular vein puncture into the right ventricle in 33 cases and into the right atrium in 1 case. Leads were secured to the skin and attached to externalized pacemakers. AFTP was used for 4 to 26 days (average 14.5 days). Re-implantation was performed in 29 patients (85.3% of the study group). There was no early infection recurrence. Three patients died during AFTP (8.8% of the study group), including two due to septic shock, and a cardiac arrest due to pulseless electrical activity in another patient. Temporary pacing with an active fixation lead is an effective and safe method to ensure a hemodynamically stable heart rhythm for a period ranging from a few to several days after the surgery in patients after transcutaneous lead extraction due to infective indications.

Mind your P's and Q's

Mind your P's and Q's

Post operative temporary epicardial pacing: When, how and why?

Temporary epicardial pacing is commonly used for the diagnosis and treatment of arrhythmias in the acute post operative period after surgery for congenital heart disease. Temporary epicardial pacemakers have become increasingly sophisticated over the years and have evolved from simple single chamber devices with few programmable parameters to complex dual chamber devices capable of adjustable parameters similar to permanent pacemakers. This review will describe the various indications for temporary pacing, technical considerations for both the choice of pacing wires and pacemaker modes, complications with temporary pacing and our current practice with temporary pacing.

How to insert a temporary pacing wire

Temporary pacing is indicated in emergency situations for treatment of bradyand tachyarrhythmias. Frequently these patients are haemodynamically unstable and so competency in temporary wire insertion is vital as immediate intervention is frequently required. Temporary pacing should form part of the procedural capabilities of any medical specialist registrar undertaking acute medical on call, especially those working in emergency medicine. F1 and F2 doctors should have be able to recognize a patient with indications for temporary pacing (Table 1) and diagnose complications of the procedure.

Temporary Pacemakers

Temporary cardiac pacing may provide definitive, and even life-saving, therapy for transient bradyarrhythmias or as a bridge to permanent pacemaker placement. Other dysrhythmias may also be amenable to therapy with temporary pacemakers. Serious dysrhythmias may develop perioperatively because of a patient's underly ing disease state, drug administration, and/or intraop erative events. The aging nature of the surgical popula tion and the increasing complexity of surgical patients' medical problems will no doubt contribute to a greater likelihood of encountering perioperative rhythm distur bances. It is therefore essential that anesthesiologists be knowledgeable regarding the indications and contra indications for temporary pacing in the perioperative period. This article describes the numerous potential indications for temporary pacing. Anesthesiologists simi larly need to be familiar with the array of temporary pacing techniques currently available. The techniques reviewed include transvenous pacing, pacing pulmo nary artery catheters, transcutaneous pacing, esopha geal pacing, and transthoracic pacing. By combining a working understanding of the use of these techniques with the technical skills necessary to implement these temporary pacing modalities, the anesthesiologist should be able to successfully establish temporary cardiac pacing.

Permanent and temporary pacemaker implantation after orthotopic heart transplantation

PURPOSE:To determine the indication for and incidence and evolution of temporary and permanent pacemaker implantation in cardiac transplant recipients. METHODS: A retrospective review of 114 patients who underwent orthotopic heart transplantation InCor (Heart Institute USP BR) between March 1985 and May 1993. We studied the incidence of and indication for temporary pacing, the relationship between pacing and rejection, the need for pemanent pacing and the clinical follow-up. RESULTS: Fourteen of 114 (12%)heart transplant recipients required temporary pacing and 4 of 114 (3.5%) patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5%) and atrioventricular (AV) block in 3 patients (21.4%). The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75%) and atrioventricular (AV) block in 1 patient (25%). We observed rejection in 3 patients (21.4%) who required temporary pacing and in 2 patients (50%) who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4%) with temporary pacing. Seven of the 14 patients (50%) died during follow-up. CONCLUSION: Sinus node dysfunction was the principal indication for temporary and permanent pacemaker implantation in cardiac transplant recipients. The need for pacing was related to worse prognosis after cardiac transplantation.

Temporary Cardiac Pacing

This book is a comprehensive review of the many aspects of temporary cardiac pacing. Initial chapters include an interesting discussion on the history of cardiac pacing and emergency measures that can be instituted before temporary pacing is established. This is followed by chapters on indications for temporary pacing, technical aspects such as establishing central venous access and positioning the leads, potential complications of the procedure, and trouble shooting for pacer malfunction. Several chapters are devoted to newer techniques and concepts in temporary pacing. A chapter is devoted to transcutaneous cardiac pacing, which may play an increasing role in the emergency setting before transvenous pacing can be established. The sections on temporary atrial and atrioventricular sequential pacing discuss the benefits and indications of these types of pacing over ventricular pacing. Although temporary atrial pacing is often not necessary, the author discusses the situations where atrial pacing can result in a significant

Temporary pacemaker use during coronary arteriography

The risk of life-threatening ventricular arrhythmias complicating coronary angiography is reportedly increased in patients in whom temporary right ventricular pacemakers are used. Placement of the temporary pacing electrode in the right atrium or vena cava during angiography theoretically removes from the vulnerable ventricle a source of mechanically or electrically induced ventricular arrhythmias. This hypothesis was evaluated in 7,648 consecutive patients who underwent cardiac catheterization with selective coronary angiography, including 103 with life-threatening ventricular arrhythmic complications. The prevalence of ventricular arrhythmias was 6.4 times greater in patients with temporary pacemakers than in those without (7% vs 1.1%, respectively, p < 0.001). Analysis of 369 cardiac catheterizations concurrently using temporary pacemakers revealed a greater than 4-fold decrease in the frequency of ventricular arrhythmias when the pacing electrodes were located in the right atrium or vena cava rather than the right ventricle (2% vs 9%, respectively, p < 0.01). No significant difference in indications for temporary pacing could be distinguished between the groups based on location of the pacing electrode or occurrence of ventricular arrhythmias. These findings confirm that there is an increased risk of ionic contrast agent-induced ventricular arrhythmias in patients with chronic underlying conduction disturbances undergoing coronary angiography with concurrent right ventricular temporary pacemakers. This risk can be significantly decreased by placing the pacing electrode in the right atrium or vena cava.

The Use of the Subclavian Vein for Temporary Transvenous Pacemaker Therapy

Temporary artificial pacing of the heart has been available clinically for the past twenty years. It was introduced as a life saving procedure for the treatment of complete arterioventricular (A-V) block and other symptomatic bradyarrhythmias. Recent developments in the field of cardiac pacemakers have resulted in pacemaker application in a wide variety of patients and the technique chosen may vary considerably with the purpose. It is of value to separate the indications for temporary pacing into urgent, semi-urgent and elective. Application of this mode of therapy requires access to the heart, a pulse generator capable of emitting a controlled electrical stimulus, and a conducting channel. In each of these areas a technology and body of knowledge has been developed. Subclavian venipuncture with catheterization is a practical procedure for the prolonged or continuous intravenous administration of different kinds of fluids. The technique of the insertion of temporary pacing lead and the point of entry vary with the indication for the procedure and the skill and experience of the operation. For the insertion of a temporary pacing electrode, several veins can be utilized; femoral, anticubical, external and interval jugular, and subclavian. Successful electrode insertion can be accomplished with relative ease through each of these veins. Selection of a vein depends upon the clinical (table: see text) situation, the availability of flouroscopic equipment and the familiarity of the operator with a specific approach.

A new temporary pacing catheter with improved sensing and safety characteristics

Temporary artificial cardiac pacing is a fully accepted procedure with widespread application. The indications for temporary pacing are numerous,‘, 2 but most temporary pacing is done for acutely ill patients who have bradyarrhythmias or tachyarrhythmias. Two serious manifestations of pacing failure are: (1) inadequate demand (standby) pacer sensing of spontaneous beats leading to competitive pacing35 4 and (21 stimulation during the vulnerable period of the preceding beat, leading to pacer-induced ventricular tachycardia or fibrillation.5*6 It is the acutely ill patient, with myocardial infarction, hypoxia, or metabolic imbalance, who is in jeopardy of improper pacing. Because of the recurrent problem of inadequate sensing in temporary pacing systems33 4* 7 and the infrequent but potentially fatal complication of competitive pacing (pacemaker-induced ventricular arrhythmia),5s 6 there is a need for a safer pacing electrode system that can avoid these complications. This report describes a unipolar pacing catheter that is designed to give improved sensing, and a decreased likelihood of pacer-induced arrhythmia even in the presence of competitive pacing. One electrode (cathode) is at the distal tip of the catheter, and the other electrode (anode) is 23 cm. proximal to the distal tip. The improved sensing derives from widely spaced electrodes, and the decreased risk of arrhythmia is a result of placing the anode outside of the heart.