Sandwell & West Birmingham NHS Trust, Birmingham, UK.
Department of Cardiology, University Hospital of Wales, Cardiff, UK.
Pacing Clin Electrophysiol. 2021 Mar;44(3):506-512. doi: 10.1111/pace.14187. Epub 2021 Feb 16.
Temporary cardiac pacing, conventionally achieved using a passive transvenous pacing wire, can be life-saving for unstable arrhythmias. However, they run the risk of complications, the longer they remain in-situ. Externalized prolonged temporary pacing (EPTP), using active-fixation lead and an externalized pulse generator; may be an alternative for transient pacing indications, concurrent illness or sepsis that precludes permanent pacing.
Sixty-seven patients (mean age 69 ± 14 years; 82% male) underwent EPTP between November 2011 and April 2019. EPTP was performed in a sterile facility, under fluoroscopy, using active-fixation leads anchored to the right ventricle septum. Externalized lead was connected to a re-sterilized pulse generator and secured to anterior chest wall with transparent dressings. EPTP indications and patient outcomes were evaluated.
Pacing indications were high-grade atrio-ventricular (AV) block (73.2%), sinus arrest (14.9%), overdrive suppression of VT (5.9%) and pause-dependent VT (4.5%). Reasons for ETPT rather than permanent pacing included: sepsis (38.8%), CIED-related infection (8.9%), transient pacing indication (25%), to allow further investigations prior to decision on CIED type (22%), and over-drive arrhythmia suppression (6%). Sixty three percent patients were severely ill in an ICU. Mean duration of pacing was 16 ± 12 days. Sixty seven percent patients subsequently received a CIED and had no evidence of device-related infection at 1-year post-implant. There were three non-fatal complications during EPTP while no deaths were attributed to EPTP.
EPTP is a safe and useful method of prolonged temporary pacing for patients who require chronotropic support, but in whom immediate permanent pacemaker implantation is contraindicated.
传统上使用被动经静脉起搏线进行临时心脏起搏可以挽救不稳定的心律失常患者的生命。然而，它们在原位停留的时间越长，就越有发生并发症的风险。使用主动固定导联和外部化脉冲发生器的外部化延长临时起搏（EPTP）可能是暂时起搏适应证、并存疾病或感染性休克导致不能立即进行永久性起搏的替代方法。
2011 年 11 月至 2019 年 4 月期间，67 例患者（平均年龄 69±14 岁，82%为男性）接受 EPTP。在无菌条件下，通过透视引导，将主动固定导联固定在右心室间隔上，进行 EPTP。将外部化导联连接到重新消毒的脉冲发生器上，并使用透明敷料将其固定在前胸壁上。评估了起搏适应证和患者结局。
起搏适应证为高度房室（AV）阻滞（73.2%）、窦性停搏（14.9%）、超速抑制 VT（5.9%）和与停搏相关的 VT（4.5%）。选择 EPTP 而非永久性起搏的原因包括：感染性休克（38.8%）、CIED 相关感染（8.9%）、暂时起搏适应证（25%）、在决定 CIED 类型前允许进一步检查（22%）和超速抑制心律失常（6%）。63%的患者在 ICU 中病情严重。起搏时间平均为 16±12 天。67%的患者随后植入了 CIED，在植入后 1 年时没有设备相关感染的证据。在 EPTP 期间发生了 3 例非致命性并发症，没有死亡归因于 EPTP。
EPTP 是一种安全有效的延长临时起搏方法，适用于需要变时支持但立即植入永久性起搏器有禁忌的患者。
