Temporary Transvenous Cardiac Pacing Research Articles

Safety of Transvenous Temporary Cardiac Pacing in Patients with Accidental Digoxin Overdose and Symptomatic Bradycardia

Background: Patients with digoxin intoxication may need transvenous temporary cardiac pacing (TCP) when symptomatic bradyarrhythmias are present. However, it has been reported that TCP might be associated with fatal arrhythmias in patients with acute digitalis intoxication caused by attempted suicide. The aim of this study was to assess the safety of TCP in patients with accidental digoxin-related symptomatic bradyarrhythmias. Materials and Methods: Seventy patients (30 men; age 74 ± 12 years) were enrolled in this retrospective study. Patients were divided into two groups: group 1 with TCP and group 2 without TCP. A digoxin overdose was defined as a serum digoxin level higher than 2.0 ng/ml combined with the presence of digoxin-related symptoms. Detailed clinical characteristics were reviewed on the basis of the medical records. Results: Group 1 included 24 patients (34.3%, 10 men). The rhythms prior to pacemaker insertion in group 1 included sinus arrest with junctional bradyarrhythmias (n = 9), atrial fibrillation with a slow ventricular rate (n = 11), and high-degree atrioventricular block (n = 4). The mean duration of pacemaker implantation was 5.8 ± 2.9 days (2–12 days). There was no major arrhythmic event or mortality after TCP in group 1. Two patients in group 2 (4%) died of ventricular tachyarrhythmias. Group 1 had a higher level of blood urea nitrogen (45.1 ± 26.0 vs. 33.4 ± 19.3 mg/dl), of left ventricular ejection fraction (68 vs. 56%), and of digoxin (4.4 ± 2.1 vs. 3.4 ± 1.3 ng/ml) but a lower serum calcium level (8.7 ± 0.6 vs. 9.1 ± 0.8 mg/dl). Conclusion: TCP was safe for patients with a digoxin overdose complicated by symptomatic bradycardia and should be recommended in such situations. However, this conclusion does not apply to acute digoxin intoxication as a result of attempted suicide.

Transvenous cardiac pacing

Transvenous pacing therapy is a life-saving technique for patients with clinically significant bradyarrhythmias. For most symptomatic bradyarrhythmias in small animals, there is no effective substitute for cardiac pacing. The methods employed for pacemaker placement, although potentially time-consuming, are not technically difficult. This article discusses the indications, techniques, clinical decision-making, and potential complications associated with temporary and permanent transvenous cardiac pacing.

Safe and Efficient Emergency Transvenous Ventricular Pacing via the Right Supraclavicular Route

Infraclavicular and internal jugular central venous access are techniques commonly used for temporary transvenous pacing. However, the procedure still has a considerable complication rate, with a high risk/benefit ratio because of insertion difficulties and pacemaker malfunction. To enlarge the spectrum of alternative access sites, we prospectively evaluated the right supraclavicular route to the subclavian/innominate vein for emergency ventricular pacing with a transvenous flow-directed pacemaker as a bedside procedure. For 19 mo, 17 consecutive patients with symptomatic bradycardia, cardiac arrest, or torsade de pointes requiring immediate bedside transvenous pacing were enrolled in the study. The success rate, insertional complications, pacemaker performance, and patients’ outcomes were recorded. Supraclavicular venipuncture was successful in all patients, in 16 of 17 at the first attempt. Adequate ventricular pacing was achieved within 1 to 5 min (median, 2 min) after venipuncture and within 10 s to 4 min (median, 30 s) after lead insertion (≤30 s in 15 of 17 patients). The median pacing threshold was 1 mA (range, 0.7 to 2.5 mA). No procedure-related complications were recorded. Throughout the pacing period of 1538 h (median: 62 h, range, 1–280 h) two reversible malfunctions caused by inadvertent lead dislodgement after 122 and 171 h were recorded; in one patient the pacemaker had to be removed because of local infection after 14 days of pacing. We conclude that the right supraclavicular route is an easy, safe, and effective first approach for transvenous ventricular pacing and might provide a useful alternative to traditional puncture sites, even in a preclinical setting. Implications: Temporary transvenous cardiac pacing can yield high complication rates especially under emergency conditions. We investigated emergency pacing via the right supraclavicular access in 17 consecutive hemodynamically compromised patients and found good safety, efficacy, and a low complication rate.

Transvenous Temporary Cardiac Pacing Practice: Pilot Study in a District General Hospital

Transvenous Temporary Cardiac Pacing Practice: Pilot Study in a District General Hospital

Inadvertent but asymptomatic right atrial perforation with epicardial pacing in a neonate: a rare complication of temporary transvenous cardiac pacing.

We report a case of an asymptomatic right atrial perforation due to temporary cardiac pacing in a neonate.

Current practice and complications of temporary transvenous cardiac pacing.

Information about the practice and complications of temporary cardiac pacing is remarkably limited. In Britain only two series have been published, and both reported the problems in patients referred to a regional cardiothoracic centre for permanent pacing who had undergone temporary pacing before transfer.1 2 This paper reports the first prospective study of temporary cardiac pacing in British district general hospitals. Of the 20 acute hospitals in the former Northern region, 18 participated in this six month prospective study. After each attempted pacing, the coronary care nursing staff completed a form which documented demographic details, the indication for pacing, and who performed (and supervised) the procedure. When more than one operator was involved the more senior doctor was recorded. Immediate complications (apparent by the end of the …

Temporary transvenous cardiac pacing: 6 years experience in one coronary care unit.

The role of temporary percutaneous endocardial pacing has been examined in a retrospective analysis of all paced patients admitted to one coronary care unit over a 6 year period. The majority of 162 cases (84.6%) were paced for complete heart block complicating acute myocardial infarction. These patients had a higher incidence of previous hypertension, myocardial infarction and diabetes, compared to matched controls (P less than 0.05, less than 0.02 and less than 0.001, respectively). Admission blood glucose levels were also higher (P less than 0.05). The in-hospital mortality was high (46.7%), especially for those with anterior myocardial infarction (74.5%). Twenty-five (15.4%) patients without recent myocardial infarction were paced for symptomatic brady-dysrhythmias, usually due to chronic complete heart block (Lenegre's disease) or sick sinus syndrome. Most later required permanent pacing. Complications of temporary pacing were more frequent in those who died, the most common being dysrhythmias during pacemaker insertion. Review of our cases suggests that whilst facilities for temporary pacing were extremely valuable, many cases treated were not haemodynamically compromised and probably did not require pacing. Guidelines should be established on coronary care units to prevent the unnecessary morbidity, mortality and expense of the procedure.

Temporary Transvenous Cardiac Pacing in the Critical Care Setting

T emporary cardiac pacing in the critical care sethng is a safe intervention which can provide life-saving therapy in a variety of clinical situations. The transvenous route involving internal jugular, subelavian, or femoral venous puncture has gained popularity for both emergent and semi-elective procedures. Although right ventricular pacing is most commonly employed, technology is available to permit temporary right atrial and dual chamber ‘� Transesopha

Cardiac Involvement in Lyme Disease: Manifestations and Management

Cardiac involvement in Lyme disease may manifest as atrioventricular block, myopericarditis, and left ventricular dysfunction. Diagnosis depends on recognition of the systemic nature of Lyme disease, including cardiac involvement, and its natural history. Serologic tests that are both sensitive and specific may aid in diagnosis. Although current recommendations for the treatment of Lyme disease with carditis include antibiotics and salicylates or corticosteroids, these types of therapy have not been unequivocally demonstrated to alter the natural history of cardiac involvement. Supportive therapy may necessitate temporary transvenous cardiac pacing in symptomatic patients.

Indications for and complications of temporary transvenous cardiac pacing.

A prospective survey was conducted of the indications for and complications of 153 temporary transvenous cardiac pacing lead insertions in 148 patients. Pacing for bradyarrhythmias or potential bradyarrhythmias (Group I) accounted for 105 insertions, wide complex tachycardia (Group II) 17, and narrow complex tachycardia (Group III) 31 pacing electrode insertions respectively. The infraclavicular subclavian vein approach was used in 73%. The median insertion time was 20 minutes. Group I: 77% were undertaken because of severe symptoms. On 64 occasions (61%) the patient had complete heart block or ventricular asystole. Group II: The lead was inserted to treat and often assist in the diagnosis of the wide complex tachycardia. Ventricular 'burst' pacing reverted ventricular tachycardia in 13 (76%). Group III: Rapid atrial 'burst' pacing was used to treat supraventricular tachyarrhythmias (paroxysmal supraventricular tachycardia and atrial flutter) resistant to medical therapy. Pacing was successful in reverting 28 (90%). A complication occurred in 27 (18%) of 153 lead insertions, 11 (7%) were serious. No complication resulted in the death of a patient. Temporary transvenous pacing is safe and effective for the treatment of bradyarrhythmias and certain tachyarrhythmias.

Symptomatic venous thrombosis of the upper extremity complicating permanent transvenous pacing: Reversal with streptokinase infusion

Symptomatic deep vein thrombosis of the upper extremity is an infrequently recognized complication of temporary or permanent transvenous cardiac pacing. When present, customary treatment includes elevation, rest, and systemic anticoagulation. We report such an occurrence, refractory to conventional management in whom dramatic improvement was observed subsequent to the institution of thrombolytic therapy with streptokinase. A 62-year-old white male factory worker was admitted to hospital with an acute 48-hour history of right arm edema, venous suffusion, and pain. Three months earlier he had undergone elective implantation of a permanent, transvenous silicone-rubber tined bipolar endocardial pacing catheter (Medtronic No. 6962) using the standard cephalic vein approach. There was no history of recent trauma, significant congestive heart failure, or prior documented thromboembolic phenomenon. On admission the patient was afebrile. The right arm was edematous and cyanotic with prominent superficial venous distention over the anterior deltoid area. The circumference of the arm at mid-bicep level was 5 cm greater than the opposite side. The right axilla was tender but without adenopathy. There was no evidence of cellulitis. The pacemaker incision site was unremarkable and pacemaker function was appropriate. An absolute platelet count and leukocyte count on admission were normal as was a prothrombin time of 11 seconds and a partial thromboplastin time of 27 seconds. A venogram of the involved extremity done on admission (Fig. 1, A) demonstrated complete obstruction of the axillary vein at its mid-point (arrows), with clot extending into the right brachiocephalic system and superior vena cava. Heparin therapy was instituted with a loading dose of 5,000 units followed by a continuous infusion of 1,000 unit&r with observed prolongation of the partial thromboplastin time to 55 seconds. In response to a lack of clinical improvement after 24 hours of heparin therapy, thrombolytic therapy with streptokinase was begun. The anticoagulant effect of heparin was reversed with protamine sulfate. A modified Ivy bleeding time, thrombin time, prothrombin time, partial thromboplastin, and fibrin split product level

Perforation of the Tricuspid Valve by a Transvenous Pacemaker

FOR the past 12 years, permanent and temporary transvenous cardiac pacing has become not only an accepted, but an indispensable and many-pronged tool. It has been used extensively in the treatment of the Adams-Stokes syndrome, and in patients with symptomatic bradyarrhythmia with or without a myocardial infarction. Recently, electrical pacemakers have been employed to override life-threatening arrhythmia refractory to pharmacologic approaches. 1 Currently, permanent cardiac pacing is usually accomplished with the insertion of an endocardial electrode through a peripheral vein. Although this approach has simplified pacemaker insertion, various complications can develop. Displacement of the catheter electrode has been reported in all large series and has had an incidence of displacement of 10% to 15%. 2,3 Other complications include disruption of the electrode, 4 atrial thrombi, 5 air embolism, 3 endothelization of the catheter, 6 phrenic nerve stimulation, and myocardial perforation. This report describes the perforation of a tricuspid value. Report

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.