Permanent Transvenous Pacemaker Implantation Research Articles

Intracardiac leadless versus transvenous permanent pacemaker implantation: Impact on clinical outcomes and healthcare utilization

BackgroundTransvenous permanent pacemakers are used frequently to treat cardiac rhythm disorders. Recently, intracardiac leadless pacemakers offer potential treatment using an alternative insertion procedure due to their novel design. Literature comparing outcomes between the two devices is scarce. We aim to assess the impact of intracardiac leadless pacemakers on readmissions and hospitalization trends. MethodsWe analyzed the National Readmissions Database from 2016 to 2019, seeking patients admitted for sick sinus syndrome, second-degree-, or third-degree atrioventricular block who received either a transvenous permanent pacemaker or an intracardiac leadless pacemaker. Patients were stratified by device type and assessed for 30-day readmissions, inpatient mortality, and healthcare utilization. Descriptive statistics, Cox proportional hazards, and multivariate regressions were used to compare the groups. ResultsBetween 2016 and 2019, 21,782 patients met the inclusion criteria. The mean age was 81.07 years, and 45.52 % were female. No statistical difference was noted for 30-day readmissions (HR 1.14, 95 % CI 0.92–1.41, p = 0.225) and inpatient mortality (HR 1.36, 95 % CI 0.71–2.62, p = 0.352) between the transvenous and intracardiac groups. Multivariate linear regression revealed that length of stay was 0.54 (95 % CI 0.26–0.83, p < 0.001) days longer for the intracardiac group. ConclusionHospitalization outcomes associated with intracardiac leadless pacemakers are comparable to traditional transvenous permanent pacemakers. Patients may benefit from using this new device without incurring additional resource utilization. Further studies are needed to compare long-term outcomes between transvenous and intracardiac pacemakers.

First Case Report of Transvenous Pacemaker Placement in a Patient with Congenital Absence of the Clavicles Due to Cleidocranial Dysplasia

Cleidocranial dysplasia is a rare, autosomal dominant disease that is associated with clavicular absence or hypoplasia. Permanent pacemakers are most commonly implanted using percutaneous subclavian venous access. The clavicle is typically used as a bony landmark to guide venous access. Transvenous pacemaker implantation in the setting of clavicular hypoplasia, resection or other anomalies has not been described in literature. This is the first case report of a patient with clavicular absence undergoing transvenous permanent pacemaker implantation. This patient has a rare condition called cleidocranial dysplasia resulting in the congenital absence of his clavicles, along with other skeletal abnormalities. Cardiac anomalies are not associated with this disorder. This patient presented for permanent pacemaker placement in the setting of trifascicular block, symptomatic intermittent second-degree Mobitz type II atrioventricular block, and syncope. Using intra-procedural subclavian venography and intraprocedural Sonosite ultrasound imaging to identify vascular anatomy and surrounding anatomic landmarks, this patient underwent successful placement of a dual chamber transvenous pacemaker. Images from the intraprocedural venogram and the post-procedure chest x-ray illustrate the anatomy in this patient with congenital absence of the clavicles. This case has important implications in subclavian access and pacemaker placement in patients with clavicular abnormalities that may include absent, deformed, or resected clavicles.

Successful transcutaneous pacing following ventricular standstill during anaesthetic induction in a dog with third‐degree atrioventricular block

Third‐degree atrioventricular block is a haemodynamically unstable bradycardia frequently resulting in signs of lethargy, weakness and collapse. In this reported case, a four year‐four month‐old male neutered Cavalier King Charles spaniel diagnosed with third‐degree atrioventricular block was referred for transvenous permanent pacemaker implantation. During induction of general anaesthesia, the dog suffered cardiac arrest consistent with ventricular standstill, as indicated by cessation of ventricular electrical activity on the ECG monitor and the absence of a peripheral pulse. The prior placement of transthoracic pacing pads under sedation allowed for rapid commencement of temporary transcutaneous pacing and proved effective in achieving ventricular capture with re‐establishment of cardiac output. The subsequent general anaesthesia for implantation of a permanent pacemaker was uneventful. This report considers the possible causes of ventricular escape rhythm suppression and highlights the importance of ensuring availability of a temporary pacing method from the outset when anaesthetising animals with unstable and symptomatic bradycardias.

The effect of a surgical safety checklist on complication rates associated with permanent transvenous pacemaker implantation in dogs

IntroductionTo determine whether use of a surgical safety checklist (SSC) would reduce the rate of major complications after permanent transvenous pacemaker implantation in dogs. AnimalsThe study included one hundred ninety-nine dogs undergoing pacemaker implantation for bradyarrhythmias at an academic teaching hospital. MethodsA service-specific SSC was developed and implemented for cardiac catheterization procedures in 2015. Medical records were reviewed to extract relevant clinical and procedural data for cases with (SSC [+]) and without (SSC [−]) a checklist. Owners or referring veterinarians were contacted for outcome and survival data. ResultsMajor complications occurred in 25/199 (12.6%) dogs. Incidence of major complications was significantly lower in SSC [+] dogs compared with SSC [−] dogs (1/45 procedures vs 24/144 procedures; p = 0.019). Dogs with SSCs were more likely to receive antibiotics within 5 min of the first incision (p = 0.0082) and to receive antibiotics every 90 min throughout the procedure as prescribed (p = 0.001) compared with dogs without SSCs. Incidence of cardiac death was lower in SSC [+] dogs compared with SSC [−] dogs (p = 0.0012), but checklist use was not associated with increased survival time (all-cause or cardiac). On average, 91% of checklist components were completed for each SSC; minor changes in record-keeping protocols could increase compliance. ConclusionsUse of an SSC was associated with a decrease in the major complication rate and an increase in compliance with antibiotic protocols during pacemaker implantation. Results of this study support the use of an SSC in veterinary cardiology procedures.

Transvenous permanent pacemaker implantation in dextrocardia: technique, challenges, outcome, and a brief review of literature

Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce. The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement. Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable.

Permanent pacemaker implantation in a patient with situs solitus, dextrocardia, and corrected transposition of the great arteries using a novel angiographic technique

Complex congenital heart diseases involving abnormalities of the atrial situs and cardiac malpositions like dextrocardia can pose a considerable challenge to transvenous permanent pacemaker implantation (PPI). Literature describing transvenous PPI techniques in patients with complex cardiac anomalies is scarce. In this report, we describe a novel angiography-guided technique for the implantation of a dual chamber transvenous pacemaker in a patient with complete heart block with situs solitus, dextrocardia, and congenitally corrected transposition of the great arteries.

Permanent transvenous pacemaker implantation following percutaneous transluminal angioplasty in a patient with asymptomatic bilateral subclavian vein stenosis

Subclavian venous obstruction is a disorder that arises more frequently today, due to the increased frequency of vascular interventions. It may aff ect one or both of the subclavian veins. When bilateral, it complicates the implantation of several devices that are preferably installed via the upper-extremity veins. Among these are pacemakers, cardiac defi brillators, catheters for haemodialysis, and even port catheters. In this study, we present a patient with symptomatic Mobitz type II AV block, who was planned to undergo a pacemaker implantation. Previously the patient had undergone two coronary bypass operations. Probably due to the interventions made at that time, he was now diagnosed with bilateral subclavian vein obstruction. Following the diagnosis, the obstruction in the right subclavian vein was successfully relieved through balloon angioplasty, after which a permanent atrioventricular pacemaker was installed.

研究 経静脈性恒久ペースメーカー植込み後の, ペーシング・センシング閾値の経時的変化の検討

研究 経静脈性恒久ペースメーカー植込み後の, ペーシング・センシング閾値の経時的変化の検討

Right ventricular failure due to postpericardiotomy syndrome following transvenous dual chamber permanent pacemaker implantation

“Pericardial effusion and tamponade are recognised complications of permanent transvenous pacemakers implantation. This is more common when active fixation leads are used. We describe a patient who developed right ventricular failure with significant pericardial effusion following permanent transvenous pacemaker implantation.”

Preoperative Atrial Size Predicts the Success of Radiofrequency Maze Procedure for Permanent Atrial Fibrillation in Patients Undergoing Concomitant Valvular Surgery

The radiofrequency (RF) maze procedure can effectively restore sinus rhythm and atrial transport function in the majority of patients with permanent atrial fibrillation (AF) and mitral valve disease. No previous study has described a cutoff value of preoperative atrial size determined by the discriminant analysis in predicting the success of sinus conversion by the RF maze procedure for permanent AF in patients with mitral valve disease. This study included 81 patients with permanent AF and mitral valve disease who underwent the RF maze IV procedure while undergoing concomitant valvular operations. There was one surgical death (1.2%). Another patient died of acute necrotizing pancreatitis 13 months later. Two patients (2.5%) developed sick sinus syndrome and received transvenous permanent pacemaker implantation. In the remaining 77 patients, there were 38 men and 39 women, with a mean (+/- SD) age of 51 +/- 11 years. At a mean follow-up time of 38 months, 65 patients (84.4%) had persistent sinus conversion that had been accomplished by the RF maze procedure (group 1), and 12 patients (15.6%) did not regain sinus rhythm (group 2). We evaluated the preoperative variables between the two groups. Univariate analysis demonstrated that the preoperative left atrial area and the left atrial diameter of group 1 patients were significantly smaller than those of group 2 patients. Group 1 had significantly fewer patients associated with tricuspid valve disease than did group 2. By multiple stepwise logistic regression analysis, only the preoperative left atrial area was an independent determinant of sinus conversion by the RF maze procedure (odds ratio, 0.961; 95% confidence interval, 0.935 to 0.988; p < 0.005). Linear discriminant analysis demonstrated that the sensitivity and specificity of the cutoff value of 56.25 cm(2) of the preoperative left atrial area in predicting the sinus conversion by the RF maze procedure were 50.0% and 86.2%, respectively, and the positive and negative predictive values were 40.0% and 90.3%, respectively. The preoperative left atrial area is an independent determinant of sinus conversion by the RF maze procedure for patients with permanent AF and mitral valve disease.

Placement of SVC Stents over Pacemaker Wires for the Treatment of SVC Syndrome

PERCUTANEOUS stent placement in the superior vena cava (SVC) has evolved as an attractive alternative to traditional therapies for benign and malignant SVC syndrome (1–6). Symptomatic stenosis or occlusion of the SVC is a rare but well-recognized complication of transvenous permanent pacemaker implantation (7,8). Several factors may increase the occurrence of venous thrombosis related to a pacemaker. The presence of more than one lead has been associated with a higher likelihood of SVC obstruction (9,10).

Long-term thrombosis after transvenous permanent pacemaker implantation.

To assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis after long-term transvenous permanent pacemaker implantation, venograms were performed in 100 consecutive patients at the elective replacement of the pacemaker. Mean follow-up period after initial transvenous permanent pacemaker implantation was 6.0 years. The venograms demonstrated normal in 77 patients. The remaining 23 venograms showed venous stenosis in 11 patients and total obstruction in 12 patients. Twenty-one of these 23 patients had venous collateral circulation. No difference was found in the incidence of venous abnormalities according to the route of entry, the lead insulation, the total number of the implanted leads, and anticoagulant and antiaggregant drugs. All these patients have remained asymptomatic. In conclusion, the incidence of venous thrombosis after long-term transvenous pacing is 23% and the causes of venous thrombosis may be endothelial trauma and underlying venous stenosis. As this article describes a retrospective limited study, we cannot find the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis formation after transvenous permanent pacemaker implantation. Further prospective study will be needed to assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs.

Venous access thrombosis detected by transcutaneous vascular ultrasound in patients with single-polyurethane-lead permanent pacemaker.

In order to assess the incidence of significant venous thrombosis after transvenous permanent pacemaker implantation, transcutaneous ultrasound studies were performed in 109 consecutive patients with single-polyurethane-lead pacemakers. Ultrasonic evaluation was found to be a good noninvasive method in assessing the veins. Six patients (5.5%) were found to have significant venous obstruction in the subclavian vein. However, none of them were symptomatic. No difference in the incidence of venous obstruction was found, based on the age, duration of implantation, operative technique, potentially thrombogenic factors including atrial fibrillation, diabeties mellitus, hypertension, heart failure and end-stage renal disease.

Permanent Transvenous Pacemaker Implantation in Forty Dogs

Permanent transvenous cardiac pacemakers were implanted in 40 dogs. Electrocardiographic diagnoses included persistent atrial standstill (3 dogs), sick sinus syndrome (8 dogs), and high-grade second-degree or third-degree atrioventricular (AV) block (29 dogs). Thirteen dogs were alive and well 4 to 42 months after pacemaker implantation (mean, 16.9 months). The mean and median survival times of the 26 dogs that died or were euthanatized during the study were 17.9 months and 13 months, respectively. Most of these dogs succumbed to problems unrelated to the arrhythmia and pacemaker implant. One dog was lost to follow-up. Complications associated with permanent transvenous pacemaker implantation included lead dislodgement, infection, hematoma formation, skeletal muscle stimulation, ventricular arrhythmia, migration of the pulse generator, and skin erosion. Lead dislodgement was the most common complication, occurring in 7 of 9 dogs paced using untined electrode leads and in 6 of 30 dogs paced using tined leads. Lead dislodgement did not occur in the only dog paced using an actively fixed endocardial lead. It was concluded that permanent transvenous cardiac pacing is a feasible, less traumatic alternative to epimyocardial pacing in dogs, but that successful use of this technique requires careful implantation technique and anticipation of the potential complications.

Damage to Cardiologists?Gloves During Cardiac Catheterization, Pacemaker Implantation, and Percutaneous Transluminal Coronary Angioplasty

Glove perforation during catheter laboratory procedures exposes the operator to potentially infected fluids and the patient to wound infection. To assess the extent of this problem, 200 consecutive pairs of surgical gloves worn during cardiac catheterization, percutaneous transluminal coronary angio-plasty (PTCA), or permanent transvenous pacemaker (PPM) insertion were examined for perforations by a water distension test. The overall puncture rate for pairs of gloves was 18%. The rate of glove puncture differed between cardiac catheterization, PPM implantation, and PTCA (21.4%, 25.6%, and 4.8%, respectively; P = 0.018). The incidence of glove damage at cardiac catheterization was significantly higher when arterial access was obtained by a brachial cut-down rather than by the Seldinger technique (25.7% and 11.3%, respectively; P = 0.015) and was independent of operator experience. Glove perforation is common. Operators should be aware of the problem and be particularly vigilent during brachial arteriotomy and PPM implantation, especially when operating on potentially infected patients. (J Interven Cardiol 1991; 4:167–170)

Short‐Term Thrombosis after Transvenous Permanent Pacemaker Insertion

In order to assess prospectively the incidence and significance of venous thrombosis early after permanent transvenous pacemaker implantation venographic studies were carried out in 40 consecutive patients. The venograms performed between 1 and 6 months (mean 4 months) after the implantation were normal in 31 patients (77%), in six patients (15%) they showed partial venous obstruction and in three patients (8%) total obstruction. Between 6 and 12 months (mean 9 months) the venograms of five patients, that were previously normal, showed partial venous thrombosis. No changes were found in the venograms performed later. Only two of 14 patients with thrombosis of the great veins was clinically symptomatic and developed arm edema, that resolved spontaneously within about a month. No difference in incidence of abnormal venograms was found according to the type of insulation, the polarity of the electrode and the route of entry.

Percutaneous Transfemoral Venous Cardiac Pacing: A Simple and Practical Method

For temporary transvenous cardiac pacing to be successful and practical (1) electrode placement must be accomplished precisely and expeditiously; (2) the inserted electrode should not move spontaneously from the chosen site of endocardial stimulation; (3) prevention of electrode displacement should not be accomplished at the cost of inconvenience to the patient; and (4) the site of venous entry for temporary pacing should not compromise plans for later permanent transvenous pacemaker implantation. Of the four available venous routes, brachial, jugular, subclavian and femoral, only the last meets all these requirements. A simple percutaneous transfemoral venous method of cardiac pacing is described, and personal experience with its use in 100 consecutive patients presented. The necessary equipment for the procedure is within the reach of any hospital. This technique is particularly valuable in management of patients with malfunctioning permanent pacemakers, acute myocardial infarction complicated by A-V block or ectopic tachyarrhythmias, recurrent Stokes-Adams attacks, and refractory ventricular tachycardia, where expediency in establishing a stable rhythm is of paramount importance.

Hazards of Cardiac Pacemaker Implantation

To the Editor:— Jensen et al ( 195 :916, 1966) are to be commended on their discussion of the hazards both potential and actual during the technique of permanent transvenous pacemaker implantation. It would certainly seem that a transvenous pacemaker, because of its ease of insertion and relatively benign implantation, would offer a wide applicability to the ill or debilitated patient. Patient 1, who returned to regular sinus rhythm after institution of permanent transvenous pacing for four days would seem to have benefited from pacing with an externalized transvenous pacemaker because of the known proclivity for short periods of complete heart block and spontaneous return to sinus rhythm during acute myocardial infarction. Bruce et al ( Amer Heart J 69 :460,1965) review a collected series in which 43% of those patients with complete atrioventricular dissociation during acute myocardial infarction returned to regular sinus rhythm during the recovery period from the myocardial infarction