Chest
Volume 64, Issue 5, November 1973, Pages 604-608
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Clinical Investigations
Temporary Transvenous Pacemaker Therapy: An Analysis of Complications

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A systematic study of the complications resulting from temporary transvenous endocardial pacing was conducted. One hundred thirteen patients requiring insertion of 142 temporary transvenous pacemaker catheters were evaluated. On 61 occasions the pacemakers were introduced through the brachial vein, and on 81 the femoral vein approach was utilized. Evidence of pacemaker malfunction, manifested as failure to capture or to sense spontaneous QRS, was encountered in 95 separate episodes or 43 percent of the total instances of insertion. Malfunction occurred in 45.9 percent of catheter pacemakers inserted through the arm vein and 40.7 percent of catheter pacemakers inserted through the femoral vein. Complications from transvenous endocardial pacing consisted primarily of ventricular tachycardia-fibrillation, myocardial perforation, pulmonary emboli, hematoma or abscess at the insertion site. Thirty-two complications were encountered in 24 instances of pacemaker therapy or 16.9 percent of the total. No deaths could be directly attributable to the complications of cardiac pacing. The high incidence of malfunctions detected during constant electrocardiographic surveillance indicate that, although temporary transvenous pacing is a safe technique, the availability of continuous electrocardiographic monitoring must be considered a prerequisite for the extensive use of temporary pacing. No significant difference could be demonstrated in the incidence of malfunction or complications from the two most commonly used sites of pacemaker insertion.

Section snippets

METHOD AND MATERIAL

The charts of 113 patients requiring the insertion of 142 temporary tranvenous demand endocardial pacemakers from Aug 1, 1967, to Jan 1, 1972, were reviewed. On 61 occasions, pacemakers were introduced through a cutdown in a brachial vein, and on 81 occasions a femoral vein approach was utilized with a modification of the Seldinger technique using a Teflon inner catheter and a dilating sheath (Percutaneous Catheter Introducer, USCI).

All were inserted in the cardiac catheterization laboratory

DISCUSSION

The safety and morbidity of the methods of temporary pacing have not yet been accurately defined, despite their widespread use throughout the world. The most likely reasons are the apparent simplicity of the techniques, predisposing to a cursory assumption of safety and resulting in a paucity of data concerning risk and incidence of complications.10

A careful assessment of the complications reported in our population indicates that ventricular arrhythmias constitute the most common complication

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Manuscript received March 27; revision accepted May 7.

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