Implante de marcapasos transitorio en una terapia intensiva municipal / Implantation of temporary pacemaker in a municipal intensive care unit

Introducción: Las bradi-arritmias son cardiopatías graves que ocasionan trastornos hemodinámicos severos; llevar al paciente a un gasto cardiaco normal puede implicar que se implante un marcapasos. Objetivo: Describir algunos aspectos clínicos y epidemiológicos de pacientes que recibieron la técnica de implantar un marcapasos. Métodos: Se realizó un estudio descriptivo y transversal, con 36 pacientes que necesitaron marcapasos transitorio, ingresados en la unidad de cuidados intensivos del Hospital General Docente "Orlando Pantoja Tamayo" de Contramaestre, en el período desde octubre de 2015 hasta mayo de 2019. Las variables utilizadas fueron: grupo de edades y sexo, causas de arritmias y antecedentes patológicos personales, medicamentos más usados previos al ingreso, tiempo de uso del marcapasos transitorio y necesidad de implantación del permanente. Resultados: Predominó el sexo masculino y edades de 80 y más años, el trastorno de la conducción auriculoventricular más frecuente fue el bloqueo auriculoventricular de tercer grado; el tiempo promedio de uso de marcapaso transitorio fue entre 2 y 6 días. Conclusiones: La implantación precoz en esta entidad municipal mejoró notablemente la supervivencia de los pacientes(AU)

Introduction: Bradyarrhythmias are serious heart diseases that cause severe hemodynamic disorders. Bringing the patient to normal cardiac output may imply that a pacemaker be implanted. Objective: To describe some clinical and epidemiological aspects of patients who received the technique of implanting a pacemaker. Methods: A descriptive and cross-sectional study was carried out with 36 patients who needed a temporary pacemaker, admitted to the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestrem, in the period from October 2015 to May 2019. The variables used were age group and sex, causes of arrhythmias, and personal pathological history, most used medications prior to admission, time of usage of the temporary pacemaker, and the need for permanent implantation. Results: The male sex and ages 80 and older predominated, the most frequent atrioventricular conduction disorder was the third-degree atrioventricular block. The average time of temporary pacemaker usage was between two and six days. Conclusions: Early implantation in this municipal institution significantly improved patient survival(AU)

Comparison of efficacy and safety of temporary pacing using active-fixation rersus traditional leads after extraction of infected leads / 中国介入心脏病学杂志

Objective To evaluate the efficacy and safety of the new active-fitation right ventricular lead temporary-permanent pacemaker (TPPM) rersus the traditional temporary transvenous pacing system .Methods Between January 2011 and June 2013, 234 patients had their infected leads removed at our center. A total of 105 (44.9%) patients were pacemaker dependent. Thirty-five patients underwent TPPM implantation and 70 patients had implanted with traditional temporary transvenous pacing system. For traditional temporary pacing, the quadrupole catheter was implanted into the right ventricle through the femoral vein to connect the temporary pacemaker. In TPPM, an active-fixation electrode was implanted into the right ventricular septum through the subclavian and internal jugular veins to connect to the reused permanent pacemaker. parameters from the pacemakers,time for the procedure,the occurance of complications and rates of infection and mortality during the 2 years of follow up were compared between the 2 groups. Results There were more patients with infectious endocarditis in the TPPM group than in the traditional temporary pacing group(22.9% vs. 5.7%,P=0.019). Therefore,the electrode retention time in the TPPM group was longer[2(2,7)d vs.2(2,3)d,P=0.032]and the hospital stay was slightly prolonged[15(14,21)d vs.17(15,25)d,P=0.05]compared with the traditional temporary pacing group.The pacing threshold in the TPPM group was lower than that in the traditional temporary pacing group[(0.7±0.2)V vs.(1.0±0.3)V, P=0.035)].There was no difference in X-ray exposure time between the groups[(24.7±15.4)min vs.(27.5±17.7)min,P=0.242].There were no complications related to bridging in the TPPM group, but 11 patients in the traditional temporary pacing group had developed complications (P=0.009). Conclusions TPPM is effective and safer as compared to traditional temporary pacing for pacemaker-dependent patients with device infection. The operation time does not increase in patients with TPPM implantation.

Observation of two temporary cardiac pacemaker electrode fixation methods / 中国实用护理杂志

Objective To observe the effect of two different methods of fixed temporary pacemaker electrode. Methods Fromn April 2015 to December 80 temporary pacemaker patients were randomly divided into control group (n = 40) and the experimental group (n = 40), the control group using gauze cloth tape cross method combined with the traditional fixed, the experimental group was treated with 3M type of comfortable and stable transparent dressing+3M pressure fixing belt fixed, to compare two groups in the skin lesions, electrode dislocation, inflammatory reaction, the switching frequency difference. Results There was no significant difference between the two groups in general data (P>0.05). There was no significant difference between the two groups in the cost of dressing and materials、electrode dislocation (P>0.05), experimental group of the switching frequency is lower than the control group (Z=-2.064, P<0.05), the differences were statistically significant. Conclusions 3M comfortable type solid transparent sticking and 3M pressurized fixed band method in the absence of increased medical costs while ensuring medical safety, save the manpower cost.

A study on temporary pacing site selection in patients with inferior acute myocardial infarction and two or three degree atrioventricular block / 中国中西医结合急救杂志

Objective To study the feasibility,effectiveness and safety of temporary pacing at the right ventricular outflow tract area in patients with inferior acute myocardial infarction(AMI)and two or three degree atrioventricular block(AVB). Methods Ninety-five patients with inferior AMI and two or three degree AVB admitted into Cangzhou People's Hospital were randomly divided into right ventricular apex pacing group(47 cases) and right ventricular outflow tract region pacing group(48 cases). Seldinger method was used to perform the right femoral vein puncture in which a 6F sheath tube was placed,and a diode temporary pacing electrode was introduced into it in the two groups. Under the X-ray guidance,in the right ventricular apex pacing group,the electrode was pushed from the inferior vena cava to enter into the right atrium,then cross the tricuspid and finally reach the right ventricular apical portion pacing. In the right ventricular outflow tract region pacing group,under the X-ray guidance, after the electrode was withdrawn and rotated slightly clockwise,it was sent forward to the right ventricular outflow tract region pacing. The duration from the puncture at the right femoral vein to the implanted electrode reaching the pacing region,the pacing threshold,the un-favorable pacing,the incidence of ventricular arrhythmia and prognosis were observed in the two groups. Results The pacing time and pacing threshold in right ventricular apex pacing group were obviously higher than those in the right ventricular outflow tract region pacing group〔pacing time(s):336±150 vs. 354±152,pacing threshold(V):0.9±0.4 vs. 0.7±0.3,both P<0.05〕. The mortality in intensive care unit (ICU)〔0(0/48)vs. 2.13%(1/47)〕,the incidence of bad pacing〔10.42%(5/48)vs. 17.02%(8/47)〕and ventricular fibrillation(VF),sustained ventricular tachycardia,contraction of non-sustained ventricular tachycardia or frequent ventricular premature beat(VPB)and other arrhythmia incidence of complications〔10.42%(5/48)vs. 12.77%(6/47)〕in the right ventricular outflow tract region pacing group were all lower than those in the right ventricular apex pacing group. Conclusion The application of right ventricular outflow tract pacing in patients with inferior AMI and two or three degree AVB is safe and effective,and its stability is fine.

On inserting a temporary pacemaker for heart bifascicular block in perioperative period / 第三军医大学学报

Objective To investigate the indications to use a temporary pacemaker for bifascicular block in perioperative period.Methods The treatment for 40 patients with heart bifascicular block and a special case were retrospectively studied.All cases,according to their disease history,clinical symptoms,physical ability and atrio-ventricular conduction ability,were divided into two groups:P group(prophylactic insertion of a temporary pacemaker) and N group(without inserting a pacemaker).During operation,we observed whether atrio-ventricular block occurs,the performance of pacemaker and atropine's therapeutic efficacy to bradycardia.Results Anesthesia was postponed in one case because of acute left bundle branch block(LBBB) and the patient died with severe myocardium damage soon after failed resuscitation.All other cases went through anesthesia and operation smoothly.Bradycardia and hypotension could be relieved somewhat by medication in operation,and no complete atrio-ventricular block developed.Conclusion There is no need inserting a temporary pacemaker for chronic bifascicular block if asymptomatic and no atrio-ventricular block.Transesophageal atrial pacing is an easy way to evaluate in quantification atrio-ventricular conduction ability.

Safety of Percutaneous Right Coronary Intervention without Temporary Pacemaker: Prospective Study

BACKGROUND: The prophylactic use of temporary pacemaker during coronary intervention has been markedly decreased since 1980's. There is, however, few systematic report focusing on right coronary intervention in which temporary pacemaker would be most beneficial. Moreover, there has been marked development in coronary intervention recent years that risk and benefit of prophylactic pacemaker should be reconsidered. METHOD: We performed right coronary artery intervention without prophylactic use of temporary pacemaker in 100 successive patients in Samsung Medical Center. Patients with previous AV block and rotational atherectomy cases were excluded. The incidence of all complications and changes of blood pressure as well as heart rate during coronary intervention were examined prospectively. RESULTS: The lesion type was B2 or C in 52% and intracoronary thrombus was found in 18% of patients. Nevertheless, there was neither life threatening bradycardia nor new onset arrhythmia in any patient during right coronary intervention. CONCLUSION: These data suggest that omission of prophylactic use of temporary pacemaker may be safe in right coronary intervention only if excluding previous patients with high degree atrioventricular block and rotational atherectomy cases. This approach may reduce procedure time and cost as well as pacemaker-associated complications.