Abstract
Objective: A prospective regional survey was carried out to describe the current practice of temporary transvenous pacing in five hospitals in the Wessex region and identify factors that predispose to complications.
Methods: Data were collected on patient characteristics, pacing indication and setting, operator grade, training, experience and supervision, venous access, procedure time, duration of pacing, complications, and eventual outcome.
Results: A total of 144 procedures were performed on 111 patients (age 75 (12) years). Median procedure time was 30 (1–150) min. Trainees performed 129 (91.5%) procedures. The senior physician present was a cardiologist/cardiology trainee for 65/144 (45.1%), and had experience of >20 procedures for 81/144 (57.9%). Venous access was by the subclavian in 52 (46.8%), internal jugular in 37 (33.3%) and femoral in 22 (19.8%), requiring multiple stabs or multiple sites in 41(33.1%). Pacing wires remained in place for a median of 2 (0.04–20) days.
Overall procedure times were shorter for cardiologists/cardiology trainees (24[1–90] v 45[10–150] min, p<0.0001), and experienced physicians (30[1–150] v 40[10–120] min, p<0.01). There were 50 complications in 46/144 (31.9%) procedures, affecting 31/111 (27.9%) patients. Immediate complications were less common with experienced physicians (1/81 v 5/59, p<0.05). Infection occurred more often with wires left in situ for >48 hours (17/86 v 2/55, p<0.01) and with longer procedure times (55[8–150] v 30[1–120] min, p<0.005). No factors predicted displacement, which occurred at a median time of 1 (0.04–8) day. Complications delayed permanent pacemaker insertion in 19/63 (22.9%) patients.
Conclusions: Temporary pacemaker insertion is performed by physicians with variable experience and training. The presence of an experienced cardiologist/cardiology trainee and decreasing the time that pacing wires remain in situ may reduce complications.
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Selected References
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