Temporary Transvenous Cardiac Pacing Research Articles

PERCUTANEOUS MITRAL PLICATION FOR WEANING BY VA–ECMO IN PATIENT WITH OBSTRUCTIVE SAM ASSOCIATED WITH PRECLINICAL PHENOTYPE OF HYPERTROPHIC CARDIOMYOPATHY AND STEMI COMPLICATED BY CARDIOGENIC SHOCK

Abstract A 53–year–old man with a history of hypertrophic obstructive cardiomyopathy with a preclinical phenotype, classified at low risk of sudden cardiac death (HCM–SCD risk score 2.98%), and cardiac arrest (OHCA) in the absence of a shockable rhythm. The patient underwent cardiopulmonary resuscitation for more than 30 minutes before the diagnosis of complete atrioventricular block, masked by concomitant atrial stand–still, resolved after transcutaneous pacing. After temporary trans–venous cardiac pacing was obtained, the electrocardiogram revealed signs of an extensive anterolateral occlusive infarction (OMI), treated with primary angioplasty during percutaneous ventricular support (Impella CP). The ICU course was characterized by several ineffective attempts to wean from mechanical assistance to the circulation finally made possible by correction of outflow obstruction from mitral SAM, achieved by percutaneous mitral plication with MitraClip system. This case, in addition to suggesting an alternative strategy of weaning from mechanical assistance to the circulation in patients with a similar hemodynamic profile (SCAI D stage cardiogenic shock by dual mechanism: pump dysfunction and outflow obstruction), offers important insights into the management of OCHA in the absence of a shockable rhythm.

Twenty-four hour continuous transvenous temporary right ventricular pacing in healthy horses.

The ability to perform transvenous temporary cardiac pacing (TV-TP) is critical to stabilize horses with symptomatic bradyarrhythmias. Reports of successful TV-TP in horses are limited, and only briefly describe short-term pacing. To describe temporary, medium-term (24 h) transvenous right ventricular pacing in awake horses using a bipolar torque-directed pacing catheter. Six healthy adult institutional teaching horses. Prospective experimental study with 2 immediately successive TV-TP lead placements in each horse with a target location of the RV apex. One placement was performed primarily with echocardiographic guidance and 1 primarily with fluoroscopic guidance. In all placements, corresponding images were obtained with both imaging modalities. Horses were then paced for 24 h, unrestricted in a stall with continuous telemetric ECG monitoring. Echocardiographically determined lead position, episodes of pacing failure in the preceding 6 h, and pacing thresholds were recorded every 6 h. Pacing failure was defined as a period of loss of capture longer than 20 s. Pacing leads were placed with both guidance methods and maintained for 24 h with no complications. Two horses with leads angled caudally in the right ventricular apex had no pacing failure, the remaining 4 horses had varying degrees of loss of capture. Leads located in the right ventricular apex had longer time to pacing failure and lower capture thresholds P < 0.05. Medium-term TV-TP is feasible and has potential for stabilization of horses with symptomatic bradyarrhythmias. Lead position in the right ventricular apex appears optimal. Continuous ECG monitoring is recommended to detect pacing failure.

Temporary transvenous cardiac pacing in cathlab - myocardial infarction versus other causes - differences, complications, and prognosis. Data from a single-center retrospective analysis.

Transvenous temporary cardiac pacing (TTCP) is a lifesaving procedure, but the incidence of complications and prognosis depends on the underlying cause. The aim of this study was to compare the characteristics, complications, and prognosis in patients with myocardial infarction (MI) requiring TTCP vs. patients with TTCP due to other causes. The present analysis involved 244 cases in whom TTCP was performed between 2017 and 2021 in a high-volume cathlab. All the procedures were performed by an interventional cardiologist. MI constituted 46.3% of the patients (n = 113), including 63 ST-segment elevation MI patients (55.75%). Non-MI patients (control group) consisted of patients with any cause of bradycardia requiring TTCP. Myocardial infarction patients requiring TTCP are younger and have a higher prevalence of hypertension and heart failure. The pacing lead is more frequently inserted during asystole/resuscitation, and pacing was needed for a longer time. MI patients required cardiac implantable electronic device implantation less frequently than in other causes (22% vs. 82%, p < 0.01). The incidence of TTCP complications did not differ. The incidence of in-hospital death was 6.5-fold higher in TTCP patients with MI. Logistic regression showed MI to be a strong predictor of in-hospital death (odds ratio: 8.1; 95% confidence interval: 1.3-57.9). In-hospital mortality in MI patients requiring TTCP is 6.5-fold higher than in other patients with bradycardia. The complication rate of TTCP is similar in MI and non-MI patients. It is not TTCP but the severity of MI itself and the fact that a pacing lead is frequently implanted in asystole or during resuscitation that is responsible for the higher mortality rate.

Chinese emergency expert consensus on bedside temporary cardiac pacing (2023)

Temporary cardiac pacing is an essential technique in the diagnosis and treatment of arrhythmias. Due to its urgency, complexity, and uncertainty, it is necessary to develop an evidence-based emergency operation norms. Currently, there is no specific consensus guidelines at home or abroad. The Emergency Branch of Chinese Medical Association organized relevant experts to draft the Chinese emergency expert consensus on bedside temporary cardiac pacing (2023) to guide the operation and application of bedside cardiac pacing. The formulation of the consensus adopts the consensus meeting method and the evidentiary basis and recommendation grading of the Oxford Center for Evidence-based Medicine in the United States. A total of 13 recommendations were extracted from the discussion on the methods of bedside temporary cardiac pacing, the puncture site of transvenous temporary cardiac pacing, the selection of leads, the placement and placement of leads, pacemaker parameter settings, indications, complications and postoperative management. The recommended consensus includes the choice between transcutaneous and transvenous pacing, preferred venous access for temporary transvenous pacing, the target and best guidance method for implantation of bedside pacing electrodes, recommended default pacemaker settings, recommended indications for sinoatrial node dysfunction, atrioventricular block, acute myocardial infarction, cardiac arrest, ventricular and supraventricular arrhythmias. They also recommended ultrasound guidance and a shortened temporary pacing support time to reduce complications of temporary transvenous cardiac pacing, recommended bedrest, and anticoagulation after temporary transvenous pacing. Bedside temporary cardiac pacing is generally safe and effective. Accurate assessment, correct selection of the pacing mode, and timely performance of bedside temporary cardiac pacing can further improve the survival rate and prognosis of related emergency patients.

Simulation-based Mastery Learning Improves Emergency Medicine Residents' Ability to Perform Temporary Transvenous Cardiac Pacing.

Temporary transvenous cardiac pacing (TVP) is a critical intervention that emergency physicians perform infrequently in clinical practice. Prior simulation studies revealed that emergency medicine (EM) residents and board-certified emergency physicians perform TVP poorly during checklist-based assessments. Our objective in this report was to describe the design and implementation of a simulation-based mastery learning (SBML) curriculum and evaluate its impact on EM residents' ability to perform TVP. An expert panel of emergency physicians and cardiologists set a minimum passing standard (MPS) for a previously developed 30-item TVP checklist using the Mastery Angoff approach. Emergency medicine residents were assessed using this checklist and a high-fidelity TVP task trainer. Residents who did not meet the MPS during baseline testing viewed a procedure video and completed a 30-minute individual deliberate practice session before retesting. Residents who did not meet the MPS during initial post-testing completed additional deliberate practice and assessment until meeting or exceeding the MPS. The expert panel set an MPS of correctly performing 28 (93.3%) checklist items. Fifty-seven EM residents participated. Mean checklist scores improved from 13.4 (95% CI 11.8-15.0) during baseline testing to 27.5 (95% CI 26.9-28.1) during initial post-testing (P < 0.01). No residents met the MPS at baseline testing. The 21 (36.8%) residents who did not meet the MPS during initial post-testing all met or exceeded the MPS after completing one additional 30-minute deliberate practice session. Emergency medicine residents demonstrated significantly improved TVP performance with reduced variability in checklist scores after completing a simulation-based mastery learning curriculum.

Outcome of emergency transvenous cardiac pacing placement by echocardiography guidance in non-cardiac centre

Temporary transvenous cardiac pacing (TTVCP) is crucial and lifesaving procedure for hemodynamically unstable bradyarrhythmia. TTVCP placement under fluoroscopy guidance is considered the “gold-standard”. However, its use is limited by equipment availability. During the COVID-19 pandemic, access to operation-theatre with fluoroscopy service is severely restricted due to delay in confirming patient COVID-19 status (COVID19 PCR 6 h, GeneXpert 2 h). With this limitation, physicians rely on echocardiography guided placement of TTVCP for unstable emergent cases.

Bedside temporary transvenous cardiac pacing lead placement in patients with tricuspid valve surgery without guidance of X‐ray: A single‐center experience

It is difficult to insert cardiac pacing leads in patient with tricuspid valve surgery (TVS). The aim of this study was to evaluate safety and effectiveness of a novel technique applied for bedside temporary pacemaker placement (TPP) in patients with TVS. We investigated patients with TVS who required bedside TPP without X-ray guidance in cardiac intensive care unit between January 2019 and March 2022. They were divided into Novel pre-shaped group (N=21) and Control group (routine pre-shaped group, N=26). The ordinary bipolar electrodes were applied in both groups. In Novel pre-shaped group, electrodes were reshaped by a novel technique with three-curve with anterior tip method, while electrodes were shaped by traditional strategy in Control group. We evaluated the operation duration, first-attempt success rate of the lead placement, pacing threshold, success rate of lead placement, the rate of leads displacement, and complications. Compared with that in Control group, the procedure time was significantly shortened and the first-attempt success rate of lead placement was obviously increased in Novel pre-shaped group (both p < 0.05). Although there was a slight reduction in complications in Novel pre-shaped group when compared with that in Control group. However, there were no statistical significance in pacing threshold, the success rate of lead placement, the rate of leads displacement, and complications when compared between two groups. We propose a novel technique, three-curve with anterior tip method, is a feasible and effective bedside method to insert emergency temporary pacing leads in patients with TVS.

Efficacy and safety of temporary permanent pacemaker: A single-center experience

Temporary cardiac pacing is commonly indicated for the treatment of symptomatic bradycardia and various types of reversible symptomatic heart block. Conventional transvenous temporary cardiac pacing therapy is widely used. This technique is associated with a number of limitations and complications, compared to permanent pacing system. The aim of our study was to identify the indications, complications and outcomes of transvenous semi-permanent pacing. A retrospective study was conducted in our cardiology department from 2017 to 2019. We investigated semi-permanent transvenous pacing system. Were included all patients presenting symptomatic heart block potentially reversible or in a context of severe infection, and patients hospitalized for alcohol septal ablation. A total of 18 patients were implanted, aged between 47 and 92 years. Seven were enrolled for STEMI with symptomatic atrioventricular block, 4 for alcohol septal ablation for hypertrophic cardiomyopathy, 1 for hyperkaliemia, 1 for myocarditis with atrioventricular block and 5 for symptomatic sinus bradycardia or atrioventricular block with infection circumstances. The venous access was sub clavicular in 17 patients (94%) and internal jugular in just 1 patient. After a median follow-up of 14.5 ± 9.63 months, the total duration of hospital stay was 13.5 ± 10.14 days. The duration of temporary pacing was 10 ± 6.27 days. A total of 12 patients (67%) were definitely implanted of dual chamber pacemaker (75%), cardio resynchronization therapy pacemaker (17%) or defibrillator (8%). One patient died with the semi-permanent pacing system in situ. No major or minor intra-operative or postoperative complication occurred. Temporary permanent pacemaker with bipolar active fixation leads and epicutaneous pulse generators provide a cost effectiveness option for prolonged temporary pacing as a bridge to permanent system implantation or recovery.

Development of a Rigorously Designed Procedural Checklist for Assessment of Emergency Medicine Resident Performance of Temporary Transvenous Cardiac Pacing.

Temporary transvenous cardiac pacing (TVP) is a potentially lifesaving intervention included in the list of essential core procedures for emergency medicine (EM) training; however, opportunities to perform TVP during residency cannot be guaranteed. EM graduates report feeling subjectively underprepared for this procedure, but objective performance data are lacking. Checklist-based simulated assessment is an increasing focus of competency-based medical education, particularly for invasive procedures like TVP. The objectives of this paper were as follows: first, to enlist a multidisciplinary team of experts to create an assessment tool for TVP using best practices in checklist development; second, to determine the reliability of checklist scoring; and third, to assess EM residents' baseline ability to perform TVP using a dedicated task trainer. This study was conducted at a single 4-year EM residency. A panel of emergency physicians and cardiologists designed a TVP checklist using a modified Delphi approach. After consensus was achieved on a final checklist, EM residents were assessed using a dedicated TVP task trainer. Inter-rater reliability was determined using Cohen's kappa coefficient. Resident performance was determined by number of correctly performed checklist items. The expert panel achieved consensus on a 30-item checklist after three rounds of revisions. The Cohen's kappa coefficient for the overall checklist score was 0.87, with individual checklist items ranging from 0.63 to 1.00. In total, 58 residents were assessed with a mean score of 13.5 of 30 checklist items. Scores increased with each year of training. This study details the rigorous development of a TVP checklist designed by a multidisciplinary team of experts. Checklist scores demonstrated strong inter-rater reliability. The overall poor performance of this cohort suggests the current approach to TVP training does not provide sufficient preparation for EM residents. Competency-based techniques, such as simulation-based mastery learning, should be explored.

Temporary transvenous cardiac pacing: a survey on current practice.

Temporary transvenous cardiac pacing (TTCP) is a standard procedure in current practice, despite limited coverage in consensus guidelines. However, many authors reported several complications associated with TTCP, especially development of infections of cardiac implantable electronic devices (CIED). The aim of this survey was to provide a country-wide picture of current practice regarding TTCP. Data were collected using an online survey that was administered to members of the Italian Association of Arrhythmology and Cardiac Pacing. We collected data from 102 physicians, working in 81 Italian hospitals from 17/21 regions. Our data evidenced that different strategies are adopted in case of acute bradycardia with a tendency to limit TTCP mainly to advanced atrioventricular block. However, some centers reported a greater use in elective procedures. TTCP is usually performed by electrophysiologists or interventional cardiologists and, differently from previous reports, mainly by a femoral approach and with nonfloating catheters. We found high inhomogeneity regarding prevention of infections and thromboembolic complications and in post-TTCP management, associated with different TTCP volumes and a strategy for management of acute bradyarrhythmias. This survey evidenced a high inhomogeneity in the approaches adopted by Italian cardiologists for TTCP. Further studies are needed to explore if these divergences are associated with different long-term outcomes, especially incidence of CIED-related infections.

Unusual ventricular activation produced by temporary transvenous cardiac pacing: electrovectorcardiographic findings

Unusual ventricular activation produced by temporary transvenous cardiac pacing: electrovectorcardiographic findings

A047 Transvenous Temporary Cardiac Pacing at Middlemore Hospital Over the Last 6 Years. A Retrospective Audit

Transvenous temporary cardiac pacing (TV-TP) is widely used to treat life-threatening arrhythmias. This audit evaluated the indications and complications of all patients that received TV-TP at Middlemore Hospital in the last 6 years. A retrospective audit from 2014-2020 of all patients treated with TV-TP in the catheterisation lab or with the portable II machine at Middlemore Hospital were included. 70 patients were included, of which 43(61%) were male. The average age was 71(41-93). 30(43%) were NZ European, 23(33%) were Pacific Island or Māori. The average BMI was 29kg/m2 (range 19-51). Complete heart block was the most common indication (36%). Myocardial infarction was seen in 10(14%) cases. 20(29%) were done prophylactically prior to planned procedures. Right femoral vein was the most common access point 55(79%). 42(60%) cases were done in the catheterisation lab, 17(24%) cases in the coronary care. The median time from decision to implantation was approximately 1.5 hours. There was a lack of complete documentation in 7 cases. The average duration of insertion was 2 days (54mins – 5 days). 45% required a permanent pacemaker, implanted on average 1.2 days later. One patient had loss of capture due to lead displacement. 6 patients died within 30 days of TV-TP due to the underlying condition. An Interventional or EP Cardiologist was involved in 53(76%) cases. Patients requiring TV-TP is done in a safe and timely manner by both interventional and non-interventional cardiologists regardless of location in the hospital. Indications and complications are in line with other studies.

Bedside temporary transvenous cardiac pacemaker placement

Temporary transvenous cardiac pacing is a life-saving procedure in an emergency. Transvenous cardiac pacing catheterization guided by intracavitary electrocardiogram (IC-ECG), instead of fluoroscope, is practical. Tips for controlling the orientation of the pacing catheter tip and utilizing IC-ECG to monitor the positions of electrodes make bedside temporary transvenous cardiac pacing catheter placement feasible and ‘visible’. The technique discussed here is comparable to the operation under fluoroscopy，but without exposure to X-ray.

A comprehensive scoping review on transvenous temporary pacing therapy.

Transvenous temporary cardiac pacing therapy (TV-TP) is widely used to treat life-threatening arrhythmias. Yet aggregated evidence on TV-TP is limited. We conducted a systematic scoping review to evaluate indications, access routes and complications of TV-TP, as well as permanent pacemaker therapy (PPM) following TV-TP. Clinical studies concerning TV-TP were identified in Ovid MEDLINE. Case studies and studies lacking complication rates were excluded. To assess complication incidence over time, differences in mean complication rates between 10-year intervals since the introduction of TV-TP were evaluated. We identified 1398 studies, of which 32 were included, effectively including 4546 patients. Indications varied considerably; however TV-TP was most commonly performed in atrioventricular block (62.7%). The preferred site of access was the femoral vein (47.2%). The mean complication rate was 36.7%, of which 10.2% were considered serious. The incidence of complications decreased significantly between 10-year interval groups, but remained high in the most recent time period (22.9%) (analysis of variance; p < 0.001). PPM was required in 64.2% of cases following TV-TP. Atrioventricular block was the primary indication for TV-TP; however indications varied widely. The femoral vein was the most frequent approach. Complications are common in patients undergoing TV-TP. Although a decrease has been observed since its introduction, the clinical burden remains significant. The majority of patients who underwent TV-TP required PPM therapy.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01307-x) contains supplementary material, which is available to authorized users.

One case of multiple thrombosis formation after temporary transvenous cardiac pacing

One case of multiple thrombosis formation after temporary transvenous cardiac pacing

Transvenous Temporary Cardiac Pacing

Transvenous temporary cardiac pacing is a rather old but still contemporary life-saving technique, with a unique value in the treatment of critically ill patients suffering from rhythm disturbances and associated hemodynamic compromise. Physicians involved in the management of such patients should always keep in mind the indications and contraindications of transvenous temporary cardiac pacing, and should be at least familiar with the insertion technique and the post-insertion care.

Relationship between seasonal weather changes, risk of dehydration, and incidence of severe bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population

There is little information on any seasonal variations or meteorological factors associated with symptomatic bradyarrhythmias requiring cardiac pacing. The aim of this single-center study was to investigate the seasonal distribution of the incidence of severe, life-threatening bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population. Consecutive patients who underwent urgent temporary transvenous cardiac pacing between 2007 and 2012 were enrolled. The baseline characteristics of the patients and some meteorological parameters, including the calculation the daily heat index (HI), were recorded. During the study period, 79 consecutive patients (mean age 82 ± 8 years, 41% male) underwent urgent temporary transvenous cardiac pacing, mainly for third-degree atrioventricular block (79%). The incidence of bradyarrhythmias was significantly higher in summer than in the other seasons (P < 0.001). Moreover, the highest incidence was observed in months with HI > 90 °F for >3 h per day for at least 10 days (P < 0.001). A direct correlation was found between the average monthly temperature and the monthly number of patients undergoing temporary cardiac pacing (r = 0.54, P < 0.001). Compared with other patients, those observed during the hottest months were significantly older and more frequently affected by chronic disabling neurological diseases (all P < 0.05). In addition, they more frequently showed biochemical indices of dehydration, renal function impairment and hyperkalemia (all P < 0.05). This study showed an increased incidence of severe bradyarrhythmias in an elderly population during the hottest months of the year. In these months, in subjects characterized by increased susceptibility to dehydration, the risk of developing bradyarrhythmias was increased significantly.

Temporary Transvenous Cardiac Pacing in Patients With Acute Myocardial Infarction Predicts Increased Mortality.

BackgroundTemporary pacemakers (TP) are used in emergency situations for severe bradyarrhythmias secondary to acute myocardial infarction (AMI) and to non-AMI related cardiac disorders. TP have been studied previously in AMI patients treated with thrombolytic therapy; limited information is available on current outcomes in AMI patients treated with percutaneous coronary intervention.MethodsWe reviewed the indications, complications, and mortality associated with TP insertion over a four year period (2003 - 2007) at a university hospital.ResultsSeventy-three temporary pacemakers were inserted (47 men, 26 women) during this period. The mean age was 65.2 years. TP were used in 29 AMI patients (39.7 % of total) and 44 non-AMI patients (60.3% of total). The duration of TP use was 2.6 ± 0.4 days in the whole cohort, 2.46 % of all AMI patients (29/1180) admitted during this period required a TP. Six of these patients requiring a TP required a permanent pacemaker. Eight patients with AMI and a TP died (27.6%). In contrast 8.9 % of AMI patients not requiring a TP died (P < 0.01). There were no statistically significant differences between the AMI and non-AMI groups in the duration of temporary pacing (2.4 ± 0.6 days vs. 2.8 ± 0.4 days), in complications (27.6% vs. 29.5%), or in mortality (27.6% vs. 15.9%). The need for a permanent pacemaker (PPM) differed significantly between the AMI and non-AMI patients (20.7% vs. 54.5%; P < 0.05).ConclusionOur results indicate that AMI patients infrequently require a TP and that approximately 20% of these patients require a PPM. These results suggest that early revascularization of the conduction system with current interventional techniques has decreased the need for TP in AMI patients. However, this group requires more intensive monitoring as the mortality rate in this group of patients is significantly higher than the other AMI patients not requiring TP.

Ten years on: has competence and training in temporary transvenous cardiac pacing improved?

Ten years ago in the pre-Calman era, Davis and Roberts (1996) examined the practice of temporary cardiac pacing in north-west England. Now, in the post-Calman and Modernising Medical Careers era, a new survey has found no improvement in this important practice.

Acute hypoxia due to right to left blood shunting in a patient with atrial septal defect

Acute right to left blood shunt is an unusual cause of acute hypoxia. We describe a case of a patient with an atrial septal defect who developed acute hypoxia due to cardiac tamponade. Acute haemopericardium developed as a complication of temporary transvenous cardiac pacing. Bubble contrast echocardiography confirmed right to left blood shunting at the atrial level. Acute hypoxaemia and the right to left blood shunt resolved when the pericardium was drained. The case underscores the importance of evaluating the presence of an intracardial shunt in patients with otherwise inexplicable hypoxia.