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.