Routine Use of Screw-In Electrodes for Temporary Pacing in Emergent Cases - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Ran Eliaz The Heart Institute, Hadassah Medical Center, Hebrew University, Jerusalem, Ein Kerem, Israel Ivaylo Tonchev The Heart Institute, Hadassah Medical Center, Hebrew University, Jerusalem, Ein Kerem, Israel Yair Elitzur The Heart Institute, Hadassah Medical Center, Hebrew University, Jerusalem, Ein Kerem, Israel Ayelet Shauer The Heart Institute, Hadassah Medical Center, Hebrew University, Jerusalem, Ein Kerem, Israel David Luria The Heart Institute, Hadassah Medical Center, Hebrew University, Jerusalem, Ein Kerem, Israel

Introduction: Temporary pacing electrodes may cause patient discomfort as well as several complications, including tamponade, lead dislodgment/disconnection, infection, pneumothorax, ventricular arrhythmias and the need for prolonged patient immobilization. The use of active screw-in pacing leads introduced via internal Jugular vein, connected to an externally fixed pulse generator, may decrease complication rate and patient discomfort.

Methods: data of patients admitted to ICCU for high degree AV block between 2016-2017 was collected. Patients were divided into 2 groups: standard temporary lead implantation via femoral vein, and Ultrasound guided active fixation screw-in pacing electrodes (Boston TM) via right internal Jugular vein. Fluoroscopy was used for lead positioning in the right ventricular apex. Clinical as well as device parameters were measured on a daily basis.

Findings: 22 patients underwent temporary pacemaker insertion, of which eight underwent successful (100%) Jugular screw-in lead implantation. Device therapy was a bridge to permanent implantation (5) or to recovery (1). Treatment duration ranged from 3 to 7 days. No bleeding, infections, lead complications (cardiac perforation/Tamponade, Arrhythmias, dislodgment, threshold increase/no capture) or major patient discomfort was noted during treatment. 1 patient suffered from mild discomfort (3 on a scale of 1-10) at the penetration site. All patients were fully mobile. In comparison, in the standard trans-femoral approach group (14) minor complications occurred in 3 patients (21%): groin hematoma, increase in threshold and need for lead repositioning due to lead dislodgment. In addition, prolonged immobility caused patient discomfort (between 5-8 on a 1-10 scale).

Conclusion: The use of ventricular screw-in pacemaker lead with externally fixed pulse generator introduced via the right Jugular vein is safe, efficient, causes less discomfort and allows patient mobility. We suggest a routine use of this approach for a variety of indications such as symptomatic bradycardias and Trans Arterial Valve Implantation (TAVI) patients.