Beneyto Maxime, Seguret Matthieu, Taranzano Marine, Mondoly Pierre, Biendel Caroline, Rollin Anne, Bounes Fanny, Elbaz Meyer, Maury Philippe, Delmas Clément
Electrophysiology and Pacing Department, Rangueil University Hospital, 31059 Toulouse, France.
Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France.
J Clin Med. 2022 Dec 4;11(23):7206. doi: 10.3390/jcm11237206.
The use of temporary cardiac pacing is frequent in critical care units for severe bradycardia or electrical storm, but may be associated with frequent and potentially severe complications, especially when indwelling for several days. In some cases, transient indication or ongoing contraindication for a permanent pacemaker justifies prolonged temporary pacing. In that case, the implantation of an active-fixation lead connected to an externalized pacemaker represents a valuable option to increase safety and patient comfort. Yet, evidence remains scarce. We aimed to describe the population receiving prolonged temporary cardiac pacing (PTCP) and their outcomes.
We retrospectively included all consecutive patients, admitted to our hospital from 2016 to 2021, who underwent PTCP. We collected in-hospital and six-month outcomes.
Forty-six patients (median age of 73, 63% male) were included, and twenty-nine (63%) had prior heart disease. Indications for PTCP were found: seventeen (37%) potentially reversible high-grade conduction disorders, fourteen (30%) indications for permanent pacemaker but ongoing infection, seven (15%) cardiac implantable electronic device infections requiring extraction in pacing-dependent patients, seven (15%) severe vagal hyperreactivity in prolonged critical care hospitalizations, and one (2%) recurrent sustained ventricular tachycardia requiring overdrive pacing. The median PTCP duration was nine (5-13) days. Ten (22%) patients exhibited at least one complication during hospitalization. Twenty-six (56.5%) patients required definite device implantation (twenty-five pacemakers and one cardioverter-defibrillator) and twenty (43.5%) did not (fifteen PTCP device removal for recovery and five deaths under PTCP). At six months, two (5%) deaths and two (5%) new infections of a definite implanted device occurred, all in patients with initial active infection.
The use of prolonged temporary cardiac pacing, with an active -fixation lead connected to an externalized pacemaker, is possible and reasonable; this would allow for the possible recovery or resolution of contraindication for definite device implantation.
在重症监护病房，临时心脏起搏常用于治疗严重心动过缓或电风暴，但可能会伴有频繁且潜在的严重并发症，尤其是在留置数日的情况下。在某些病例中，永久性起搏器的短暂适应证或持续禁忌证使得延长临时起搏成为必要。在此种情况下，植入连接外置起搏器的主动固定电极导线是提高安全性和患者舒适度的一项有价值的选择。然而，相关证据仍然匮乏。我们旨在描述接受延长临时心脏起搏（PTCP）的人群及其预后情况。
我们回顾性纳入了2016年至2021年间我院收治的所有连续接受PTCP的患者。我们收集了住院期间及6个月时的预后情况。
共纳入46例患者（中位年龄73岁，63%为男性），其中29例（63%）既往有心脏病史。PTCP的适应证如下：17例（37%）为潜在可逆的高度传导阻滞，14例（30%）为永久性起搏器适应证但存在持续感染，7例（15%）为起搏依赖患者因心脏植入式电子设备感染需要拔除设备，7例（15%）为在延长的重症监护住院期间出现严重迷走神经高反应性，1例（2%）为复发性持续性室性心动过速需要超速起搏。PTCP的中位持续时间为9（5 - 13）天。10例（22%）患者在住院期间出现至少一种并发症。26例（56.5%）患者需要植入确定性设备（25例起搏器和1例心脏复律除颤器），20例（43.5%）患者不需要（15例因恢复而拔除PTCP设备，5例在PTCP期间死亡）。在6个月时，发生了2例（5%）死亡和2例（5%）确定性植入设备的新感染，均发生在最初有活动性感染的患者中。
使用连接外置起搏器的主动固定电极导线进行延长临时心脏起搏是可行且合理的；这将使确定性设备植入的禁忌证有可能恢复或解除。
