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Feasibility and safety of exclusive echocardiography-guided intravenous temporary pacemaker implantation

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Abstract

Background

The standard approach for urgent trans-venous temporary cardiac pacemaker (TVTP) implantation is fluoroscopy guidance. The delay in activation of the fluoroscopy-room and the transfer of unstable patients may be life-threatening. Echocardiography-guided TP implantation may increase the safety of the patients by obviating the need for in-hospital transfer. We examined the feasibility and safety of echocardiography-guided vs. fluoroscopy-guided TVTP implantation.

Methods

From January 2015 to September 2017 data for consecutive patients who needed emergent TVTP implantation were retrospectively reviewed. Ultrasound-guided TVTP protocol that was introduced in our center in January 2015 involved ultrasound guidance for both central venous access and pacing lead positioning. Access sites included femoral, subclavian, or jugular veins. Electrodes were placed in the right ventricular apex by means of echocardiographic monitoring in intensive care unit or by fluoroscopic guidance. Endpoints were achievement of successful ventricular pacing and procedural complications.

Results

Sixty-six patients (17 echocardiography-guided and 49 fluoroscopy-guided) were included. There were no differences in pacing threshold between the echocardiography-guided group and the fluoroscopy-guided group (0.75 ± 0.58 mA vs. 0.57 ± 0.35 mA, p = 0.24). The access site for implantation was femoral vein in 27% for the fluoroscopy-guided vs. none for the echocardiography-guided approach (p = 0.015). One hematoma and one related infection occurred in the fluoroscopy-guided group. The need for electrode repositioning was observed in 1 patient in each group. There were no procedural-related deaths in either group.

Conclusions

Echocardiography-guided temporary cardiac pacing is a feasible and safe alternative to fluoroscopy-guided approach and significantly lowers the need for in-hospital transfer.

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Abbreviations

POCUS:

Point-of-care ultrasound

TVTP:

Trans-venous temporary cardiac pacemaker

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Funding

This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Correspondence to Aref El Nasasra.

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Conflict of interest

Author Aref El Nasasra declares that he has no conflict of interest. Author Hilmi Alnsasra declares that he has no conflict of interest. Author Doron Zahger declares that he has no conflict of interest. Author Tsahi T Lerman declares that he has no conflict of interest. Author Sergio Kobal declares that he has no conflict of interest. Author Carlos Cafri declares that he has no conflict of interest. Author Moti Haim declares that he has no conflict of interest. Author Lior Fuchs declares that he has no conflict of interest. Author Avi Shimony declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The need to obtain an informed consent was waived due to the retrospective nature of the study.

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El Nasasra, A., Alnsasra, H., Zahger, D. et al. Feasibility and safety of exclusive echocardiography-guided intravenous temporary pacemaker implantation. J Echocardiogr 17, 157–161 (2019). https://doi.org/10.1007/s12574-018-0406-4

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  • DOI: https://doi.org/10.1007/s12574-018-0406-4

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