The indications and safety of prolonged temporary pacing using active-fixation leads and externalized pulse generator.

Shah, Nisar H, Shah, Parin, Elsayed, Hossam, O'Callaghan, Peter, Leong, Fong T and Yousef, Zaheer (2021) The indications and safety of prolonged temporary pacing using active-fixation leads and externalized pulse generator. Pacing and clinical electrophysiology : PACE. ISSN 1540-8159. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://onlinelibrary.wiley.com/doi/10.1111/pace.1...

Abstract

BACKGROUND

Temporary cardiac pacing, conventionally achieved using a passive transvenous pacing wire, can be life-saving for unstable arrhythmias. However, they run the risk of complications, the longer they remain in-situ. Externalized prolonged temporary pacing (EPTP), using active-fixation lead and an externalized pulse generator; may be an alternative for transient pacing indications, concurrent illness or sepsis that precludes permanent pacing.

METHODS

Sixty-seven patients (mean age 69 ± 14 years; 82% male) underwent EPTP between November 2011 and April 2019. EPTP was performed in a sterile facility, under fluoroscopy, using active-fixation leads anchored to the right ventricle septum. Externalized lead was connected to a re-sterilized pulse generator and secured to anterior chest wall with transparent dressings. EPTP indications and patient outcomes were evaluated.

RESULTS

Pacing indications were high-grade atrio-ventricular (AV) block (73.2%), sinus arrest (14.9%), overdrive suppression of VT (5.9%) and pause-dependent VT (4.5%). Reasons for ETPT rather than permanent pacing included: sepsis (38.8%), CIED-related infection (8.9%), transient pacing indication (25%), to allow further investigations prior to decision on CIED type (22%), and over-drive arrhythmia suppression (6%). Sixty three percent patients were severely ill in an ICU. Mean duration of pacing was 16 ± 12 days. Sixty seven percent patients subsequently received a CIED and had no evidence of device-related infection at 1-year post-implant. There were three non-fatal complications during EPTP while no deaths were attributed to EPTP.

CONCLUSION

EPTP is a safe and useful method of prolonged temporary pacing for patients who require chronotropic support, but in whom immediate permanent pacemaker implantation is contraindicated.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Cardiology
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Depositing User: Mrs Yolande Brookes
Date Deposited: 25 Feb 2021 14:59
Last Modified: 25 Feb 2021 14:59
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4025

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