Introduction
Temporary transvenous cardiac pacing is a well-established treatment
procedure performed emergently in cases of life threatening
bradyarrhythmia, such as complete (3rd degree) heart
block, prolonged symptomatic sinus pause or to prevent fatal ventricular
arrhythmia refractory to medical treatment.(1-3) The
ultimate purpose of temporary pacemakers is to stabilize the hemodynamic
status and electrical conduction until the underlying condition (e.g.,
myocardial infarction, heart failure, drug intoxication, Lyme disease,
etc.) is treated, or a permanent pacemaker is
implanted.(4,5)
A conventional Balloon-Tipped Temporary Pacemaker (BTTP) consists of a
pulse generator box connected to the myocardium with a balloon-tipped
lead with passive or no active fixation mechanism.(6)It is commonly placed by femoral or internal jugular vein
access.(7) While BTTP is the most common type of
temporary pacemaker used in clinical practice, it may be associated with
multiple complications, including lead dislodgement (due to passive
fixation) leading to loss of capture, access site infection, and venous
thromboembolism.(6,8-10) BTTP can be placed via
jugular, femoral, or subclavian access, balloon tipped catheters remain
in a stable position in the right ventricular apex. Patients with BTTP
typically need to be admitted to the intensive care unit (ICU) for
continuous monitoring and maintained on strict bedrest because of the
risk of lead dislodgement and loss of capture.(8,11)Use of BTTP also requires a higher skill of nursing and other medical
personnel who are well-educated and well-versed in the mangement and
troubleshooting for any of the above complications.
On the other hand, Temporary Permanent Pacemakers (TPPM) are placed
using active fixation leads, where the tip of the lead is “screwed
into” the myocardial septum, giving it significantly more
stability.(6) Venous access can be obtained from the
internal jugular or the subclavian vein but not usually via the femoral
vein. This provides ease of mobility to the patient and decreases the
requirement of ICU level nursing and monitoring. Typically, a permanent
pacemaker pulse generator is connected to the lead and secured to the
skin on the chest or neck, depending on the site of access(Figure 1) . TPPM is being used more frequently recently due to
its potential benefits compared to BTTP. Two prior studies in 2003 and
2006 compared TPPM and BTTP in relatively small numbers of patients and
found that TPPM is associated with a smaller risk of dislodgement and
loss of capture.(8,11) However, these studies did not
have sufficient statistical power to evaluate other clinically important
outcomes such as a potential reduction in the incidence of venous
thromboembolism associated with patient mobility or utilization of
hospital resources. Available data on the use of TPPM outside the ICU is
scarce. Considering the importance of temporary pacing, understanding
the risks and benefits of each technique is crucial for optimal patient
care. For this reason, we conducted this observational study, evaluating
the clinical and safety profile of TPPM compared to the BTTP. In
addition to that, we also assessed the safety of TPPM outside the ICU
setting.