Contemporary Trends in Utilization and Complications of Temporary Transvenous Cardiac Pacing Therapy - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Guy Rozen Cardiovascular Institute, Baruch Padeh Medical Center, Tiberias, Israel Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA Seyed Mohammadreza Hosseini Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA M. Ihsan Kaadan Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA Yitschak Biton Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA E. Kevin Heist Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA Moussa Mansour Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA Jeremy Ruskin Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA

Background: Temporary transvenous cardiac pacing (TCP) is a common and potentially lifesaving intervention that is used for the temporary management of serious bradyarrhythmias.

Objectives: To investigate nationwide trends in utilization and complications of TCP in the U.S. using the National Inpatient Sample (NIS) database.

Methods: Using the NIS database, we identified patients who underwent TCP placement in the U.S. between 2003-2014, not in the context of cardiac surgical interventions. Baseline patient demographics, clinical characteristics, Deyo-Charlson Comorbidity Index (DCCI), hospital level characteristics and outcomes including procedural complications, need for permanent pacemaker (PPM) implantation and mortality were analyzed.

Results: An estimated total of 208,406 patients underwent TCP during the study period. The median age (IQR) was 77 (67-84) years and 50.2% were male. There was a significant 15.1% decline in TCP use (Ptrend=0.013) over the years. This was driven by a 40.1% decline in TCP utilization in rural and non-teaching hospitals between 2003-2014 (Ptrend<0.001), while implantation volumes at teaching hospitals increased by 19.1% during the same period (Ptrend<0.001). Patients exhibited an increasing prevalence of comorbidities including hypertension (Ptrend<0.001), diabetes mellitus (Ptrend=0.003), and chronic kidney disease (Ptrend<0.001), resulting in an increased prevalence of high DCCI ≥2 from 42.6% to 59.7%, (Ptrend<0.001) between 2003 and 2014. The rate of procedural complications increased over the study period from 11.5% to 17.7% (Ptrend<0.001). The proportion of patients receiving PPM during the same time increased from 52.5% to 61.9% (Ptrend<0.001). In-hospital mortality in this high-risk population declined by 28.4% from 17.6% in 2003 to 12.6% in 2014 (Ptrend<0.001).

Conclusion: These data demonstrate a significant decrease in the utilization of TCP in the U.S. between 2003-2014. The TCP patient population shows an increasing prevalence of comorbidities. TCP placement was associated with an increase in the rate of procedural complications, however in-hospital mortality declined significantly during the study period.