Feasibility and Safety of Exclusive Echocardiography-Guided Intravenous Temporary Pacemaker Implantation

Background

The standard approach for urgent temporary pacemaker (TP) implantation in hemodynamically unstable patients is fluoroscopy-guided. However, the delay in activation of the fluoroscopy-room and the need for transfer of unstable patients may expose the patient to life-threatening risks. The use of point-of-care ultrasound is increasing in several emergency settings and invasive procedures. This tool may increase the safety of procedures, shorten procedural time and obviate the need for in-hospital transfer. Data on echocardiography-guided TP implantation is limited. We aimed to compare the feasibility and safety of echocardiography-guided vs. fluoroscopy-guided TP implantation.

Methods

From January 2015 to December 2016 data for consecutive patients were retrospectively collected. The choice of implantation approach was at the operator`s discretion. Access sites included femoral, sub-clavian, or jugular veins. The electrodes were placed in the right ventricular apex by means of continuous echo monitoring from subcostal or 4-chambares views or by fluoroscopic guidance. Endpoints were achievement of successful ventricular pacing and procedural complications.

Results

Fifty seven patients (13 echocardiography-guided and 44 fluoroscopy-guided) were included. Echocardiography-guided procedures were done in the emergency-room or intensive care unit while fluoroscopy-guided procedures were performed in the catheterization laboratory. No statistically significant difference between the echocardiography-guided group and the fluoroscopy-guided group was observed in pacing threshold (0.48±0.63 mA vs. 0.32±0.52 mA, P=0.37). The access site for implantation was femoral vein in 25% for the fluoroscopy-guided approach vs. none for the echocardiography-guided approach. One hematoma and one related-infection occurred in the fluoroscopy-guided group. There were no complications related to echocardiography-guided pacing. The need for electrode repositioning was observed in 2 patients from the echocardiography-guided group vs.1 patient from the fluoroscopy-guided group. There were no procedural-related deaths in either group.

Conclusions

Echocardiography-guided temporary cardiac pacing is a feasible and safe alternative to fluoroscopy-guided approach and significantly obviates the need for in-hospital transfer.