Sofi Najeeb Ullah, Sinha Santosh Kumar, Ali Araf, Samrat Siddharth, Razi Mahmodullah M, Sharma Awadhesh Kumar, Sachan Mohit, Pandey Umeshwar, Thakur Ramesh
Department of Cardiology, LPS Institute of Cardiology, GSVM, GT Road, Swaroop Nagar, Kanpur, UP, 208002, India.
Department of Ophthalmology, SKIMS Medical College, Srinagar, Kashmir, India.
Egypt Heart J. 2022 Apr 25;74(1):33. doi: 10.1186/s43044-022-00271-z.
Temporary pacing is usually performed by cardiologists under fluoroscopic, echocardiographic, or ECG guidance. However, in the developing world, there are inadequate number of cardiologists, and C-arm, catheterization laboratories, or echocardiography are not available at primary or secondary healthcare facilities. In addition, in emergencies option of fluoroscopy and echocardiography is limited. So these patients are transferred to a facility where cardiologists and these facilities are available. Crucial time is lost in transit, which leads to increased mortality. In this study, we aimed to evaluate the safety, efficacy, and practicability of unguided temporary pacemaker insertion.
A total of 1093 patients were enrolled in this study. After cannulating the internal jugular vein or subclavian vein, the pacing lead attached to the pulse generator was advanced blindly till ventricular pacing was achieved. Procedural success was taken as the primary endpoint. Secondary endpoints included the number of attempts taken for successful central venous puncture and procedural time. Complications and mortality were assessed for safety outcomes. Finally, the position of the pacing lead was assessed after the procedure on X-ray or fluoroscopy. The procedure was successful in all but one patient in whom a femoral vein approach was required because of brachiocephalic vein obstruction. Right internal jugular access was achieved in 981 (89.75%) patients. The mean number of attempts taken for achieving successful venous accesses was 1.54 ± 0.85; however, in 726 (66.42%) patients it was achieved in the first attempt. The mean procedural time was 11.5 ± 2.1 min. Overall, 117 (10.70%) patients developed complications; however, most of them were minor. Pneumothorax developed in 12 (1.1%) patients, of whom 2 needed an intercostal tube. Pericardial effusion was seen in 21 (1.92%) patients. Pacing lead tip was located in the right ventricular cavity abutting interventricular septum or free wall in 843 (77.20%) patients. No mortality attributable to procedure occurred.
Unguided temporary pacing via jugular or subclavian venous approach in an emergency setting is possible with high success and a low complication rate. Thus, it is a safe and effective procedure, and clinicians working at primary and secondary healthcare levels should be encouraged to perform this procedure. Trial registration UMIN Clinical Trials Registry, UMIN000046771. Registered 28 January 2022-Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053348.
临时起搏通常由心脏病专家在荧光透视、超声心动图或心电图引导下进行。然而，在发展中国家，心脏病专家数量不足，基层或二级医疗机构没有C形臂、导管室或超声心动图设备。此外，在紧急情况下，荧光透视和超声心动图的应用受限。因此，这些患者会被转至有心脏病专家和这些设备的医疗机构。转运过程中会耽误关键时间，从而导致死亡率上升。在本研究中，我们旨在评估非引导式临时起搏器植入的安全性、有效性和实用性。
本研究共纳入1093例患者。在穿刺颈内静脉或锁骨下静脉后，将连接脉冲发生器的起搏导线盲目推进，直至实现心室起搏。手术成功被视为主要终点。次要终点包括成功进行中心静脉穿刺的尝试次数和手术时间。评估并发症和死亡率以确定安全性结果。最后，术后通过X射线或荧光透视评估起搏导线的位置。除1例因头臂静脉阻塞需采用股静脉途径的患者外，其余所有患者手术均成功。981例（89.75%）患者成功进行了右颈内静脉穿刺。成功实现静脉穿刺的平均尝试次数为1.54±0.85次；然而，726例（66.42%）患者在首次尝试时即成功。平均手术时间为11.5±2.1分钟。总体而言，117例（10.70%）患者出现并发症；然而，大多数并发症较轻微。12例（1.1%）患者发生气胸，其中2例需要放置肋间引流管。21例（1.92%）患者出现心包积液。843例（77.20%）患者的起搏导线尖端位于右心室腔，靠近室间隔或游离壁。未发生与手术相关的死亡。
在紧急情况下，通过颈静脉或锁骨下静脉途径进行非引导式临时起搏成功率高且并发症发生率低。因此，这是一种安全有效的手术，应鼓励基层和二级医疗机构的临床医生开展此手术。试验注册 日本大学医学情报网络临床试验注册中心，UMIN000046771。2022年1月28日注册——追溯注册，https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053348。
