Bedside Versus fluoroscopy guided temporary pacemaker implantation- comparison of baseline conditions and safety outcomes

Background: Temporary pacemaker (TPM) implantation is essential for stabilizing patients with cardiac conduction impairments. Typically performed in catheterization labs or operating rooms with fluoroscopic guidance, urgent cases may require bedside implantation without fluoroscopy, using a jugular/subclavian approach. Objective: To compare the safety of TPM implantation performed in catheterization labs/operating rooms with fluoroscopic guidance (Standard Group) versus bedside without fluoroscopy (Bedside Group). Results: Between October 2020 and Marach 2023 187 patients were admitted in our ICCU with high degree AV block, of which 37 were unstable and required urgent TPM implantation (51% male average age 80.05±10.7 years). TPM was implanted bedside in 19 patients (Bedside Group) and under fluoroscopy in 18 patients (Standard Group). There were no significant differences between the groups concerning baseline characteristics and clinical presentation. Reposition due to non capture was required in 4 patients, 2 in the bedside group and 2 in the standard group (p=0.95). No significant differences were observed between the groups concerning other complications including haemoglobin drop, pneumothorax, and pericardial effusion. Concerning fever and infection indicators (WBC count, CRP levels)- fever was observed in 16.7% of the Standard Group and 31.6% of the Bedside Group (P=0.290), WBC levels had a median of 11.16 (IQR 10.02–12.68) in the Standard Group and 9.38 (IQR 7.70–14.05) in the Bedside Group (P= 0.242) and CRP levels had a median of 5.40 (IQR=0.82–11.40) in the Standard Group and 3.60 (IQR=1.20–10.48) in the Bedside Group (P= 0.837). Bacteraemia was observed in one patient in the bedside group and 1 patient in the standard group. Conclusion: Bedside TPM implantation is as safe as standard fluoroscopic implantation, supporting its use in urgent situations.