Bedside Temporary Transvenous Pacemaker Insertion in the Emergency Department: Single-Center Experience

Abstract

Objectives: Insertion of a temporary transvenous pacemaker (TTPM) is one of the life-saving interventions performed in the emergency department (ED). The aim of the study was to determine demographic, clinical characteristics, and in-hospital outcomes of patients who underwent TTPM insertion due to hemodynamically unstable bradyarrhythmia in the ED. Methods: In our study, 234 consecutive patients who underwent TTPM insertion at the bedside in the ED between January 2014 and October 2019 were included in the study. Etiological characteristics, electrocardiographic (ECG) findings, requirements for permanent pacemaker (PPM), and in-hospital mortality of the patients were analyzed retrospectively. Results: Extrinsic causes were the most common etiology of unstable bradyarrhythmia (57.6%). Most extrinsic causes were drug therapy-related factors (60.7%). Bradyarrhythmia persisted in 60% of patients after extrinsic causes were eliminated. The most common ECG finding was a high-degree atrioventricular block (62%). PPM was implanted in 44% of patients. In-hospital mortality rate was 19.7%. In the multivariate regression analysis, the left ventricular ejection fraction (LVEF) and diastolic blood pressure (DBP) measured at admission (p<0.001 and p<0.001, respectively) were determined to be independent predictors for in-hospital mortality. Conclusion: First diagnosis and intervention in the ED are of great importance for patients with unstable bradyarrhythmia. The fastest possible TTPM insertion in the ED can reduce mortality by reducing the exposure time to hypoperfusion of vital organs, especially in patients with reduced LVEF and low DBP. Furthermore, it should be kept in mind that an underlying latent conduction system disease can also be present in bradyarrhythmias thought to occur potentially due to extrinsic factors.

Transesophageal echocardiography (TEE)-guided transvenous pacing (TVP) in emergency department

“…Temporary transvenous pacemaker placement (TVP) is an emergency procedure that is within the scope of practice of a trained emergency medicine physician [4][5][6][7] for patients with unstable bradyarrhythmias. Due to the increasing use and benefits of the transesophageal probe, the intensivist and emergency department physician must be trained to handle this probe smoothly.…”

An overview of brady dysrhythmias in the emergency department

“…Acute myocardial infarction, drug misuse and side effects, electrolyte imbalance, and idiopathic and degenerative illnesses of the conduction system are a few examples of heterogeneous situations that can result in unstable bradyarrhythmias that require temporary transvenous pacemaker placement. 5 The purpose of this research is to review the available information about an overview of bradydysrhythmias in the emergency department.…”

Effects of atrioventricular blocks in acute coronary syndrome: Long-term follow-up.

“…Patients with ACS associated persistent or hemodynamic instability bradyarrhythmias warrant consideration of temporary ventricular pacing (TVP). [ 7 - 9 ] A permanent pacemaker is not typically necessary for bradyarrhythmias following ACS because bradyarrhythmias are transient in most cases. [ 8 ] Several days of the observation period were suitable for a permanent pacemaker decision.…”