Does a permanent bipolar active pacing lead connected to an external generator reduce pacing-related adverse events compared to a conventional pacing wire in patients with systemic infection and bradyarrhythmia?
Transvenous temporary pacing using an active fixation lead connected to an external generator is safer and associated with significantly fewer adverse events than conventional passive pacing catheters in patients with systemic infection.
BACKGROUND: Permanent pacemaker implantation usually is contraindicated in patients with systemic infection. The aim of the present study was to compare two different techniques of transvenous temporary pacing to bridge the infectious situation until permanent pacemaker implantation under infection-free conditions is possible. METHODS AND RESULTS: Forty-nine patients with systemic infection and hemodynamic-relevant bradyarrhythmia/asystole were temporarily paced using either a conventional pacing wire/catheter (n = 26, reference group) or a permanent bipolar active pacing lead, which was placed transcutaneously in the right ventricle and connected to an external pacing generator (n = 23, external lead group). In both groups, there were no significant differences in patient characteristics. Whereas the sensing values were almost identical, the median pacing threshold was significantly higher in the reference group (1.0 V vs 0.6 V, P < 0.05). Within comparable duration of pacing (median: 8.2 vs 7.7 days), there were 24 pacing-related adverse events (including dislocation, resuscitation due to severe bradycardia, or local infection) in the reference group as compared to one event in the external lead group (P < 0.01). None of these complications resulted in cardiac death. CONCLUSION: Thus, transvenous pacing with active fixation is safe and associated with a significantly lower rate of pacing-related adverse events as compared to the standard technique of transvenous pacing using a passive external pacing catheter.
Braun et al. (Tue,) studied this question.