A Review of Temporary Permanent Pacemakers and a Comparison with Conventional Temporary Pacemakers

Abstract

Temporary cardiac pacing is commonly used in patients with life-threatening bradycardia and serves as a bridge to implantation of a permanent pacemaker (PPM). For years, passive fixation leads have been used for this purpose, offering the advantage of that they can be placed at bedside. The downside, however, is that patients must remain on telemetry and bed rest until lead removal due to the risk of displacement and failure to capture. Even then, the latter cannot always be prevented. Temporary cardiac pacing with passive fixation leads has also been related to a higher incidence of infection and venous thrombosis, delayed recovery, and increased length of stay. Thus, over the last couple of decades, pacemaker leads with an active fixation mechanism have become increasingly used. This is known as a temporary PPM (TPPM) approach, which carries a very low risk of lead dislodgement and allows patients to ambulate, among other advantages. Here, we performed a review of the literature on the use of TPPMs and their advantages over temporary pacemakers with passive fixation leads and in order to evaluate the advantages and disadvantages of active and passive fixation leads in temporary cardiac pacing. Most articles found were case reports and case series, with few prospective studies. We excluded documents such as editorials and image case reports that provided little to no useful information for the final analysis. The literature search was performed in PubMed, Google Scholar, and other databases and articles written in English and Spanish were considered. Articles were screened up to January 2017. The search keywords used were "temporary permanent pacemaker," "external permanent pacemaker," "active fixation lead," "explantable pacemaker," "hybrid pacing," "temporary permanent generator," "prolonged temporary transvenous pacing," and "semipermanent pacemaker." A total of 24 studies with 770 patients were ultimately included in our review. The age group was primarily above the sixth decade of life, with the exception of one that included pediatric patients. Indications for pacing included device infection, sick sinus syndrome, atrioventricular block, ventricular tachycardia, and bradyarrhythmias associated with systemic illness. The duration of TPPM usage varied from a few days up to 336 days. A total of 18 (2.3%) TPPM-related infections were reported, in which the duration of TPPM use was less than 30 days in at least 15 patients. Loss of capture was documented in only eight patients (1.0%). Complication rates varied from 0% to 30%, with the highest event rates being present in studies that used femoral venous access. In conclusion, although no high-quality studies were identified in our literature search, we found the data retrieved suggest the association of overall favorable outcomes with the use of TPPMs. Device placement and removal typically involve a simple procedure, although fluoroscopy, usually applied in the cardiac catheterization laboratory, is necessary for implantation, which could represent an addition...

Working on the dirty side—the ipsilateral subclavian access for temporary pacing after lead extraction

“…While a classic temporary pacing lead could theoretically be used via the ISA, our centre only uses standard permanent pacing leads. The advantages of standard permanent active fixation leads have already been shown in other studies 10,11 and are considered preferable by guidelines, 3 even though they may be associated with higher cost. Despite active fixation, a small but considerable proportion of patients (8.3%) experienced lead displacement, probably due to pathophysiological changes during sepsis.…”

“…In this case series, consecutive patients undergoing temporary pacing via the ISA after TLE had no increased risk of local or systemic adverse events. Days from extraction to reimplantation 14 (11)(12)(13)(14)(15)(16)(17)(18)(19) The ISA may be considered as an alternative to conventional venous accesses, especially in case of unavailability of jugular, femoral or contralateral subclavian accesses. It may be advantageous due to the following reasons: First, the access can be gained without additional puncture in case of TLE with sheaths.…”

Incidence of carditis and predictors of pacemaker implantation in patients hospitalized with Lyme disease

“…The use of temporary transvenous pacemakers is usually limited to few days, and requires immobilization and continuous telemetry monitoring, with risk for dislodgement, infection or cardiac perforation [ 42 ]. The use of temporary-permanent pacemakers (TPP), has been proposed as a strategy to reduce the rate of PPM implant rate in cases of Lyme carditis where cardiac conduction system recovery is prolonged [ 22 , 43 – 45 ]. However, there are only a few published reports of TPP use in patients with Lyme carditis, and further investigation is required [ 42 , 43 ].…”

Evaluation of safety and feasibility of leadless pacemaker implantation following the removal of an infected pacemaker

“…The instability of the temporary pacing system often leads to dislocation. 7,8 The bridging method involving the use of an active fixed electrode to connect a permanent pacemaker can provide a better solution to the problems caused by a traditional temporary pacemaker in terms of the use, time, and safety. [9][10][11] At our center, for cases of simple local pocket infection, the bridging method involving an active fixed electrode with an external permanent pacemaker after electrode removal and debridement is used to ensure the demand pacing of the patients (data not shown).…”