López Ayerbe Jorge, Villuendas Sabaté Roger, García García Cosme, Rodríguez Leor Oriol, Gómez Pérez Miquel, Curós Abadal Antoni, Serra Flores Jordi, Larrousse Eduardo, Valle Vicente
Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
Rev Esp Cardiol. 2004 Nov;57(11):1045-52.
Temporary pacemakers (TP) are used in the emergency treatment of patients with severe bradyarrhythmia. They are often used in emergency situations and for older patients in poor general condition who are hemodynamically unstable and uncooperative. The aim of this study was to review and analyze the indications, incidence and type of complications associated with TP implanted in our center during a 6-year period.
We analyzed significant clinical variables, indication, route of insertion, follow-up, complications, and duration of temporary pacing.
A total of 568 TP were implanted, and 530 cases were available for review (mean age 74.8 [11] years). The main indications were symptomatic complete AV block (51%), prophylaxis for replacement with a definitive pacemaker (14.7%), blockage in the acute phase of myocardial infarction (12.6%), bradyarrhythmia due to drug intoxication (12.2%), symptomatic sick sinus syndrome (7.5%) and long QT interval or ventricular tachycardia (2.5%). The route of insertion was via the femoral vein in 99% of the cases. The duration of TP use was 4.2 days (range 1 to 31 days). A total of 369 patients (69.6%) required a permanent pacemaker.
34 patients died (6.4%), but only 3 deaths were attributable to TP implantation. Other severe complications were seen in 98 patients (18.5%). Malfunction of the TP occurred in 48 patients (9%) because of electrode displacement.
Temporary pacemakers are used in older patients with extreme bradyarrhythmia and occasionally with acute myocardial infarction. Serious complications are not uncommon (22% of all patients), and can range from femoral hematoma to cardiac tamponade and even death (6%). In 9% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.
临时起搏器（TP）用于严重缓慢性心律失常患者的紧急治疗。它们常用于紧急情况以及一般状况较差、血流动力学不稳定且不配合的老年患者。本研究的目的是回顾和分析我们中心在6年期间植入TP的适应证、发生率及相关并发症类型。
我们分析了重要的临床变量、适应证、插入途径、随访情况、并发症及临时起搏持续时间。
共植入568台TP，530例可供回顾分析（平均年龄74.8[11]岁）。主要适应证为有症状的完全性房室传导阻滞（51%）、预防性更换永久性起搏器（14.7%）、心肌梗死急性期传导阻滞（12.6%）、药物中毒所致缓慢性心律失常（12.2%）、有症状的病态窦房结综合征（7.5%）以及长QT间期或室性心动过速（2.5%）。99%的病例插入途径为经股静脉。TP使用持续时间为4.2天（范围1至31天）。共有369例患者（69.6%）需要植入永久性起搏器。
34例患者死亡（6.4%），但仅3例死亡归因于TP植入。98例患者（18.5%）出现其他严重并发症。48例患者（9%）因电极移位导致TP功能障碍。
临时起搏器用于患有严重缓慢性心律失常的老年患者，偶尔也用于急性心肌梗死患者。严重并发症并不少见（占所有患者的22%），范围从股部血肿到心脏压塞甚至死亡（6%）。9%的患者因感知失败或心室夺获丧失需要重新调整电极位置。
