Background: Temporary cardiac pacing is an established method of pacing support in unstable bradyarrhythmias. Conventional temporary pacing is fraught with risks if used beyond few days. Extended period of pacing may be required where permanent system implant indication might either be unclear or not feasible due to an intercurrent illness. An alternative approach is using active fixation transvenous pacing leads with an externalised pulse generator. We present our experience of using this technique in a tertiary cardiac centre.
Methods: All patients who received externalised prolonged temporary pacing device (EPTP device) at University Hospital of Wales from November 2011 to April 2019 were included in the analysis. The data was retrospectively obtained from our devices database and clinical information system. The EPTP procedure was conducted in a sterile procedure room. Venous access was achieved in a standard way and new active fixation pacing leads were advanced under fluoroscopic guidance, fixed to the myocardium and sutured to the skin using the anchoring sleeve. The leads were then connected with recycled, re-sterilised pulse generator and attached to the skin using adhesive transparent dressing. Standard nursing care of the site was carried out for the duration of pacing.
Results: 68 patients with a mean age 69 ± 14 years (82% male) had an EPTP device implanted over an 8-year period. The most common indication for pacing was symptomatic high-grade AV block (68%), recurrent sinus arrest, pause-dependent ventricular tachycardia and monomorphic ventricular tachycardia. The reasons for opting an EPTP device was concomitant sepsis precluding permanent system implant (32%), need for pacing support while awaiting further investigations to confirm the diagnosis (15%) and for over drive pacing (6%). A significant number of patients were being treated on the intensive care for sepsis or organ support with post-operative status or complicated medical admission. The mean duration of pacing support was 16 ± 12 days. Subsequently, 89.5% patients had a permanent device implanted. Lead displacement was most common complication in 7 of 8 patients who experience complications. There were no deaths attributed to EPTP device placement.
Conclusions: EPTP device provides safe and reliable option for prolonged temporary pacing in patients requiring pacing support while undergoing treatment for sepsis or other intercurrent illness precluding permeant system implant. This technique is particularly useful in intensive care setting where it allows frequent patient turning without risk of lead dislodgment.