Temporary Pacemaker Wire Research Articles

Abstract 2112: Silent Killer: The Rare And Potentially Lethal Right Coronary Artery Aneurysm

Giant coronary artery aneurysms, defined as diameters larger than 20 mm, are exceedingly rare and constitute a life-threatening occurrence. This case involves a patient with a giant right coronary artery (RCA) aneurysm and multivessel coronary artery disease, successfully managed by surgical intervention through quintuple coronary artery bypass grafting (CABG). A 65-year-old male with a history of hypertension presented with acute-onset chest pain. The initial workup revealed an inferolateral ST-segment elevation myocardial infarction (STEMI). The patient underwent emergency coronary angiography revealing a high-grade stenosis in the proximal and mid left anterior descending coronary artery, along with a remarkably tortuous and enlarged mid to distal RCA aneurysm measuring (21mm wide x 20mm long) and featuring significant post aneurysmal stenosis. Attempts at percutaneous angioplasty were unsuccessful due to extensive thrombosis in the RCA. The patient continued to experience active chest pain, necessitating the placement of an intra-aortic balloon pump in the right common femoral artery, the insertion of a temporary pacemaker wire to address bradycardia, and the initiation of pressor support for hypotension. Additionally, intravenous heparin and antiplatelet therapy were administered. Finally, the patient underwent a quintuple CABG to address the multivessel disease. Coronary artery aneurysm is an uncommon yet potentially perilous condition. The selection of appropriate management and intervention is crucial for averting fatal consequences associated with coronary artery aneurysms.

VDI pacing with temporary esophageal and transvenous pacemaker leads to treat post-cardiac surgery cardiogenic shock

BackgroundPost-operative atrio-ventricular (AV) block after cardiac surgery is not uncommon in high-risk patients.Case presentationOur case highlights the management of a 62-year-old female with cardiogenic shock post-cardiac surgery with concomitant complete heart block. With VVI pacing proving ineffective, it was postulated that the patient may benefit hemodynamically from AV sequential pacing, re-establishing her atrial kick. We describe a novel technique of attaching a temporary pacemaker wire to an orogastric tube to sense atrial p-waves and pace the ventricle transvenously to perform AV sequential pacing. This was done temporarily to stabilize the patient’s hemodynamic status while awaiting a permanent pacemaker implantation.ConclusionsIn hemodynamically unstable post-cardiac surgery patients with complete heart block in whom VVI pacing fails to improve their clinical status, clinicians should consider VDI pacing with an orogastric atrial sensing pacemaker lead, in consultation with the cardiac surgeon and the electrophysiology team. Of note, the patient needs to have underlying organized atrial activity for this setup to work.

The pitfall of gastric perforation by temporary pacemaker wires

The pitfall of gastric perforation by temporary pacemaker wires

Rapid ventricular pacing during transcatheter valve procedures using an internal device and programmer: A demonstration of feasibility.

To develop a protocol for using a pre-existing, permanent pacemaker or defibrillator device for rapid ventricular pacing during transcatheter valve procedures and demonstrate feasibility. Placement of a passive fixation, temporary pacemaker wire is considered routine during most transcatheter valve procedures to facilitate controlled or rapid ventricular pacing at the time of balloon expansion or valve deployment. Many patients presenting for such procedures have a pre-existing, permanent pacemaker or defibrillator device which could be used for the same function, obviating the need for temporary pacemaker wire placement. We developed a strategy for rapid pacing from the pre-existing device using a programmer during transcatheter valve procedures in consecutive patients over a 3-month period. Complications and clinical outcomes were recorded. There were 135 transcatheter valve procedures performed during the study. Of these, 28 (20.7%) had pre-existing devices (17 transcatheter aortic valve replacement, 3 aortic valve-in-valve, 2 mitral valve-in-valve, and 6 balloon aortic valvuloplasty). All patients underwent rapid ventricular pacing using a commercially available device programmer. There were no adverse events related to device pacing and no patients required placement of a temporary pacemaker wire during the procedure. At 30-days follow-up, there were no deaths, one major vascular complication related to arterial access, and one patient with renal failure requiring dialysis. Pacing from a commercially available device programmer is safe, feasible, and may reduce both procedural cost and complications such as cardiac tamponade by avoiding placement of a temporary pacemaker lead during transcatheter valve procedures.

Risk Factor for Cardiac Permanent Pacemaker Infection.

Cardiac pacemaker infections have increased globally due to increase in demand and lack of adequate knowledge about its significantly contributing risk factors. This study was therefore aimed to determine the prevailing causative microbes and risk factors of both single and dual chamber permanent pacemaker infections. This was a retrospective case control study. Cases were selected as culture positive swab, Temporary pacemaker wire or catheter were matched with three controls for each variable using chi square test. Multivariate regression analysis was done to determine risk factors. Among 47 cases, 23.4% cases were infected by methicillin resistant staph aureus, 14.9% by methicilin susceptible Staphylococcus aureus, 10.6% by pseudomonas, 8.5% by escherichia coli and 6.4% by klebsiella. Temporary pacemaker/Central line placed >24 hours ago before permanent pacemaker implantation, remnant pacemaker leads, corticosteroid use, no antibiotic prophylaxis, diabetes, smoking and non-absorbable stitches had statistically significant association with permanent pacemaker infection using multivariate regression model analysis. Chronic obstructive pulmonary disease and non-absorbable stitches had a non-significant association. Temporary pacemaker/Central line placed >24hours before permanent pacemaker implantation, remnant pacemaker leads, corticosteroid use, no antibiotic prophylaxis, diabetes, smoking and use of non-absorbable stitches are risk factors for permanent pacemaker infection. Staph aureus is the most prevalent microorganism causing infection.

Safety of temporary pacemaker wires.

It is routine practice to insert temporary pacemaker wires in cardiac surgery patients. In selected patients, temporary pacemakers are helpful in the management of cardiac surgery patients intra- and postoperatively. Although this practice is generally safe, a small percentage of patients may have complications at the time of insertion, during pacing postoperatively, at the time of pacemaker wire removal, or if temporary wires are retained inside the body. This review will shed some light on the safety issues of temporary pacemaker wire usage.

Video demonstrating access and placement of the sheath, temporary pacemaker wire and ICE catheter of another patient

Video demonstrating access and placement of the sheath, temporary pacemaker wire and ICE catheter of another patient

RAPID VENTRICULAR PACING DURING TRANSCATHETER VALVE PROCEDURES USING AN INTERNAL DEVICE AND PROGRAMMER: A DEMONSTRATION OF FEASIBILITY

Placement of a passive fixation, temporary pacemaker wire is considered routine during most transcatheter valve procedures to facilitate rapid ventricular pacing and reduce cardiac contractility at the time of balloon expansion or valve deployment. Many patients presenting to such procedures have a

Temporary Epicardial Pacing After Valve Replacement: Incidence And Predictors.

Temporary pacemaker wires are usually inserted in patients after valve replacement and may be beneficial for optimizing myocardial function in patients that develop postoperative hemodynamically significant arrhythmias [Elmi 2002]. Indications for temporary cardiac pacing (TCP) are atrial, ventricular or atrioventricular pacing for bradyarrhythmias and for management of both atrial and ventricular tachyarrhythmias [De Belder 1990; Liebold 1998].Pacemaker wires have two ends - one end has a small needle, which is passed into the myocardial surface, then is cut off. The needles may be coiled or clipped for better fixation. On the other end, the larger needle is used to penetrate the body wall, to pass the wire through to the body surface. There is debate about the ideal site for wire insertion, with agreement that the most common site of insertion is in the right ventricle [Hurle 2002].The complications of PMWs include: bleeding, tamponade, arrhythmias, and even retention with its serious hazards [Kapoor 2011; Smith 2013]. During removal of PMWs, there may be atrial or ventricular lacerations which lead to bleeding and to developing tamponade. This may prolong the hospital stay of patients, especially patients on anticoagulant medications. This study was done on patients who received pacing wires during cardiac surgery. The purpose of the study was to predict risk factors that could lead to cardiac pacing after valve surgery.

Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

BackgroundRe-exploration for bleeding accounts for increased morbidity and mortality after major cardiac operations. The use of temporary epicardial pacemaker wires is a common procedure at many departments. The removal of these wires postoperatively can potentially lead to a serious bleeding necessitating intervention.MethodsFrom Jan 2011 till Dec 2015 a total of 4244 major cardiac procedures were carried out at our department. We used temporary epicardial pacemaker wires in all cases. We collected all re-explorations for bleeding and pericardial tamponade from our surgical database and then we focused on the late re-explorations, meaning on the 4th postoperative day and thereafter, trying to identify the removal of the temporary pacemaker wires as the definite cause of bleeding. Patients’ records and medication were examined.ResultsThirty-nine late re-explorations for bleeding, consisting of repeat sternotomies, thoracotomies and subxiphoid pericardial drainages, were gathered. Eight patients had an acute bleeding incidence after removal of the temporary wires (0.18%). In four of these patients, a pericardial drainage was inserted, whereas the remaining patients were re-explorated through a repeat sternotomy. Two patients died of the acute pericardial tamponade, three had a blood transfusion and one had a wound infection. Seven out of eight patients were either on dual antiplatelet therapy or on combination of aspirin and vitamin K antagonist.ConclusionsA need for re-exploration due to removal of the temporary pacemaker wires is a very rare complication, which however increases morbidity and mortality. Adjustment of the postoperative anticoagulation therapy at the time of removal of the wires could further minimize or even prevent this serious complication.

Recreating the Sinus Node by Somatic Reprogramming: A Dream Come True?

Electronic pacemakers have been the standard of care for over 50 years for patients with symptomatic bradycardia caused by conditions such as sick sinus syndrome, complete heart block, and congenital heart block. Effective, electronic devices are subject to hardware malfunction, recalls of generators and leads, implantrelated complications and infections. Although the incidence is not high, device-related infections continue to rise, affecting over 2% of device implants and often requiring complete hardware removal and treatment with systemic antibiotics, hospitalization, and placement of a backup temporary pacemaker wire in pacemaker-dependent patients. Another important at-risk population that could benefit from biological pacemakers are fetuses with congenital heart block (frequently related to maternal antiRo/SSA antibodies). Those patients cannot receive intra-uterine electronic devices and frequently develop fatal hydrops-fetalis because of their inability to maintain an adequate heart rate to support the circulation. As an alternative to electronic devices, our group and others have been working for over a decade to develop biological alternatives to electronic pacemakers. Many important contributions have been made to the field, and, despite positive popular press (eg, Briggs), skeptical opinions have been expressed by experts in the field about the prospects of clinical application. The purpose of the present editorial is to review the different biological pacemaker strategies focusing on the potential for human translation.

Incidental Extraction of a Temporary Epicardial Pacemaker Wire With Right Ventricular Perforation During Endomyocardial Biopsy: A Case Report

IntroductionRight ventricular perforation during endomyocardial biopsy is an unusual, although potentially life-threatening, complication caused with the tip of the bioptome. The majority of perforations in heart transplant patients can be managed without surgery owing to adhesions nearly obliterating pericardial space. Case ReportWe report a case of heart transplant patient who suffered right ventricular perforation as a consequence of incidental extraction of a temporary epicardial pacemaker wire during a routine endomyocardial biopsy sampling. ConclusionsThe patient suffered no clinical consequences.

Incidental extraction of a temporary epicardial pacemaker wire with right ventricular perforation during endomyocardial biopsy

Incidental extraction of a temporary epicardial pacemaker wire with right ventricular perforation during endomyocardial biopsy

Utility and safety of temporary pacing using active fixation leads and externalized re-usable permanent pacemakers after lead extraction

After extraction of an infected cardiac implantable electronic device (CIED) in a pacemaker-dependent patient, a temporary pacemaker wire may be required for long periods during antibiotic treatment. Loss of capture and under sensing are commonly observed over time with temporary pacemaker wires, and patient mobility is restricted. The use of an externalized permanent active-fixation pacemaker lead connected to a permanent pacemaker generator for temporary pacing may be beneficial because of improved lead stability, and greater patient mobility and comfort. The aim of this study was to investigate the efficacy and safety of a temporary permanent pacemaker (TPPM) system in patients undergoing transvenous lead extraction due to CIED infection. Of 47 patients who underwent lead extraction due to CIED infection over a 2-year period at our centre, 23 were pacemaker dependent and underwent TPPM implantation. A permanent pacemaker lead was implanted in the right ventricle via the internal jugular vein and connected to a TPPM generator, which was secured externally at the base of the neck. The TPPM was used for a mean of 19.4 ± 11.9 days (median 18 days, range 3-45 days), without loss of capture or sensing failure in any patient. Twelve of 23 patients were discharged home or to a nursing facility with the TPPM until completion of antibiotic treatment and re-implantation of a new permanent pacemaker. External TPPMs are safe and effective in patients requiring long-term pacing after infected CIED removal.

Transradial rotablation in a patient with dextrocardia and acute ST-elevation myocardial infarction

An 82-year-old gentleman with situs inversus and dextrocardia was admitted to our unit following thrombolysis for inferior ST-elevation myocardial infarction (STEMI). Due to ongoing ischemic symptoms, he underwent emergency transradial coronary angiography. His culprit right coronary artery (RCA) was heavily calcified with severe stenosis in the mid and distal segments. Therefore, rotational atherectomy was performed for debulking, and four drug eluting stents were deployed in the RCA. To the best of our knowledge, this is the first reported case of successful transradial rotablation percutaneous coronary intervention in acute STEMI in a patient with dextrocardia. We also did not use temporary pacemaker wire insertion (TPW) because of the risk of right ventricular perforation (RV) in inferior STEMI with RV involvement.

An Unusual ECG Artifact? Re: ST Elevation in One Lead

We read with great interest the article entitled “ST Segment Elevation in One Lead: A Case Report” by Doctors Rifal and Dia in a recent issue of the journal.1 In their manuscript, the authors describe an ECG with ST-segment elevation in a single lead, which had been caused by the connection of the ECG electrode to a temporary pacemaker wire in a patient recovering postoperatively from coronary artery bypass grafting (CABG). This entity might, in fact, be more common than one might initially believe. Our research group recently reported on the same phenomenon occurring in a single lead (Fig. 1) in another patient who was recovering

Clinical Pearls

Guidelines for appropriate patient assessments after procedures are often not evidence based. The standard after removal of temporary pacer wires is to monitor “routine” vital signs (VS) at set intervals. To determine if current procedures for obtaining VS after temporary pacemaker wire removal (TPWR) effectively identify risks for cardiac tamponade (CT), Mahon and colleagues reviewed 23 717 cardiothoracic surgery cases with 23 reoperations for CT following TPWR. Blood pressure changes were the most common single symptom after TPWR and before reoperation for CT. Other findings were bleeding in 6 cases (26%), dyspnea in 26% of reviewed patients, and infrequent heart rate changes. Based on these findings, the authors suggest the following:—Elisabeth George,rn, phdSee Article, pp 432–440In a retrospective study, Nye and colleagues compared scores of the Glasgow Coma Scale (GCS) and 3 published “slim” versions of the National Institutes of Health Stroke Scale (NIHSS) with the full NIHSS to evaluate the value of these measures in detecting neurologic disability. Study findings revealed the following:These findings uphold the American Stroke Association and Brain Attack Coalition Guidelines for use of the NIHSS to quantify neurologic disability in acute stroke patients.— Karen A. McQuillan,rn, ms, cns-bc, ccrn, cnrnSee Article, pp 442–448McAdam and colleagues studied the levels of psychological distress in family members of high-risk intensive care unit (ICU) patients and found that psychological symptoms decreased 3 months after the ICU stay but remained high enough to warrant concern. Nurses may be able to recognize symptoms of stress in family members by observing the following:Preventive measures to respond to family needs may include these techniques:—Janet Mulroy,rn, msn, acnp, ccns, ccrnSee Article, pp 386–394

Cardiac Tamponade After Removal of Temporary Pacer Wires

After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. To determine risk factors for cardiac tamponade after temporary pacemaker wire removal. Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4). Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes. Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.

Transcutaneous aortic valve implantation using the axillary/subclavian access with patent left internal thoracic artery to left anterior descending artery: Feasibility and early clinical outcomes

Both retrograde femoral and subclavian artery catheterization techniques have been described as the most common methods for the implantation of the Medtronic CoreValve percutaneous aortic valve (Medtronic Inc, Minneapolis, Minn). The subclavian artery has been shown to be a safe and effective alternative access route in patients with unfavorable femoral access. Of the patients who are identified as candidates for subclavian artery access, a subset possess a patent left internal thoracic artery to left anterior descending artery. This patent left internal thoracic artery presents an additional anatomic and clinical variable that must be taken into consideration to ensure procedural safety and efficacy. We describe the Medtronic CoreValve percutaneous aortic valve implantation using the subclavian arterial approach in patients with a patent left internal thoracic artery and report our study's findings. The CoreValve percutaneous aortic valve is a self-expandable nitinol-based frame with a porcine pericardial valve. The subclavian access was created by a small infraclavicular surgical incision to expose the artery. Rapid ventricular pacing was used to reduce cardiac output to perform the balloon aortic valvuloplasty via a 12F sheath inserted into the subclavian artery. An 18F sheath was then inserted into the artery down into the ascending aorta and used for introduction of the delivery catheter and implantation of the percutaneous aortic valve. With the use of this method, 19 patients (76 ± 13 years) whose surgical risk was deemed excessive because of severe comorbidity and in whom transfemoral catheterization was considered unfeasible or at risk of severe complications have received implants. Subclavian artery or left internal thoracic artery injury did not occur in any patient. Two deaths occurred. One patient died of right coronary artery occlusion during the procedure, and one patient died 48 hours after the procedure as the result of a tamponade after the temporary pacemaker wire ablation. This initial experience suggests that subclavian transarterial aortic valve implantation in patients with a patent left internal thoracic artery to left anterior descending artery is feasible and safe with satisfactory short-term outcomes.

Left ventricular “temporary pacemaker wire”: a viable option in emergency situation

Left ventricular “temporary pacemaker wire”: a viable option in emergency situation