7 Indications Spectrum for Temporary Cardiac Pacemaker Therapy in a Community Hospital

Background We sought to study the indications, complications and course of patients admitted to a community hospital and needed temporary pacemaker. Method We studied 181 consecutive patients who needed a temporary pacemaker between 04/2001 and 04/2003. Results A total of 181 patients were studied. The average age was 76.1 ± 12.3, 100 males, 81 females. The commonest site of insertion was right subclavian (45%) followed by right femoral vein (27%), right internal jugular vein in 18%, left femoral vein in 9%. The commonest indication for temporary pacemaker was sick sinus syndrome and symptomatic bradycardia (56%) as a bridge for permanent pacemaker. 47 (25.9%) needing temporary pacemaker had an acute coronary syndrome as their cause, 14 (29%) of which died of cardiac complications, 9 had persistent conduction defect needing permanent pacemaker. 25 of these patients had infarction involving the inferior wall. Non essential medications causing symptomatic bradycardia needing temporary pacemaker was found in 29 (16%) of patients. 20 (11%) patients had hyperkalemia (medication induced or renal failure) and 3 patients had digoxin toxicity as the cause of conduction disturbance. 6 patients needed temporary pacemaker as their permanent pacemaker generator had reached end of life. Conclusion Temporary support of conduction system prior to placement of permanent pacemaker was the commonest cause of temporary pacemaker in our study. Myocardial infarction needing temporary pacemaker is a high risk group patient with a high mortality. Iatrogenic cause of conduction disturbance is a frequent cause for need of temporary pacemaker.