CardiologyEmergency medicine–trained physicians are proficient in the insertion of transvenous pacemakers☆
Introduction
Since the first report of an endocardial pacing electrode being used in the setting of complete heart block in 1958, temporary transvenous pacemakers have become invaluable in the treatment of a number of bradydysrhythmias.1 The use of a temporary transvenous pacing wire is a demanding procedure in terms of the technical skill necessary to perform the procedure and the training needed to promptly recognize the indications and associated complications. There have been few reports in the literature describing the success and complications of inserting a temporary transvenous pacemaker. The literature that is available describes temporary transvenous pacemaker use in ICU or coronary care units, where the environment can be controlled more easily than in the emergency department (ED). To our knowledge, no study to date has evaluated the use of a temporary transvenous pacemaker by emergency medicine specialty—trained physicians in the acute care setting, although a recent case series described the placement of a temporary transvenous pacemaker by emergency physicians using ultrasonographic guidance.2
This study sought to document the success and complication rates for temporary transvenous pacemaker insertions classified by the specialty training of the supervisor.
Section snippets
Study design
This study involved a retrospective chart review by 2 trained, unblinded data abstracters, involving all patients with a billing code for temporary transvenous pacemaker insertion at our institution between December 1999 and December 2003.
Setting
The record review was conducted at an urban academic ED with a 3-year residency-training program. The study period was selected 1 year after the institution of formalized training in 1998 for the appropriate use of temporary transvenous pacemaker wires. Before
Results
A total of 158 temporary transvenous pacemakers were placed in 154 patients by 10 emergency medicine core faculty and 8 cardiologists between December 1999 and December 2002. Of these temporary transvenous pacemakers, 24 were placed in the setting of new-onset asystole, 4 were placed in the cardiac catheterization/electrophysiology laboratory, and 13 were placed without direct attending supervision, leaving 117 temporary transvenous pacemaker insertions eligible for study. Thirty (26%) of the
Limitations
This study is limited by the retrospective nature of the data abstraction. Although the physicians involved received annual continuing medical education that addressed adequate and appropriate procedural documentation, the retrospective review was vulnerable to recording errors and omissions. We began our record review guided by previous literature that reported known temporary transvenous pacemaker and central venous access complications.3, 4, 5, 6, 7, 8 However, attributing remote
Discussion
Neither the success nor the complication rates associated with placing temporary transvenous pacemaker wires was observed to be statistically different between the specialties of emergency medicine and cardiology. All the emergency physicians who participated in this study were emergency medicine residency trained and participated in the initial didactic and annual temporary transvenous pacemaker skills workshops, which would suggest that the instruction received as part of the core competency
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Cited by (30)
Transvenous Pacemaker Placement: A Review for Emergency Clinicians
2024, Journal of Emergency MedicineTemporary transvenous pacer placement under transesophageal echocardiogram guidance in the Emergency Department
2020, American Journal of Emergency MedicineCitation Excerpt :After 30 min of ACLS, CPR was stopped, and the patient expired. Successful capture rate in ED TVP placement is reported to range from 10 to 90% [3,8,18]. TTE has been used as an adjunct but the presence of transcutaneous pacer/defibrillator pads, body habitus, bowel gas, and CPR requirements may preclude its use.
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society
2019, Journal of the American College of Cardiology2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2019, Journal of the American College of Cardiology
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Author contributions: All authors participated in the theoretical formulation and study design. RHB, JT, and TM took primary responsibility for data abstraction and database structure. RHB, TJG, and WMB conducted data analysis. RHB drafted the manuscript, and all authors contributed substantially to the revision and presentation of the final work. All authors take responsibility for the paper as a whole.
Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, Boston, MA, May 2003.
The authors report this study did not receive any outside funding or support.
Reprints not available from the authors.