Temporary Transvenous Pacing

Chapter 51 Temporary Transvenous Pacing



Teresa DeFrancesco, DVM, DACVIM (Cardiology), DACVECC



KEY POINTS



• Temporary transvenous pacing refers to a minimally invasive modality in which a pacing lead is inserted, either via the jugular or femoral vein, into the right ventricle. A current is generated from a temporary pulse generator that is external to the body.

• Indications for temporary transvenous cardiac pacing are emergency stabilization of a patient with symptomatic, medically refractory bradycardia, usually as a bridge to permanent pacing or when the bradycardia is transient or reversible, as with drug overdoses.

• Temporary transvenous cardiac pacing is preferred over the transcutaneous when pacing is required for longer than a few hours.

• The most common complication with temporary transvenous pacing is lead dislodgement and loss of capture. Other complications include thrombosis, bleeding, infection, ventricular arrhythmias, and cardiac perforation.


INTRODUCTION


Temporary transvenous cardiac pacing is a minimally invasive technique used primarily to correct profound medically refractory bradycardia in hemodynamically unstable patients.1-3 Temporary cardiac pacing is also useful prophylactically to support heart rate and blood pressure in patients with sick sinus syndrome or high-grade atrioventricular block who are undergoing general anesthesia for permanent pacemaker implantation. The need for any type of temporary cardiac pacing for permanent pacemaker implantation is debatable in patients who are hemodynamically stable. However, in patients with erratic ventricular escape rhythms or with extremely low ventricular escape rates (<30 beats per minute [bpm]), temporary pacing does improve cardiac output and blood pressure during anesthesia until the permanent pacing system is in place.


Additionally, prophylactic use of temporary pacing during permanent pacemaker implantation ensures rapid rescue if problems such as asystole arise. Arguments against temporary transvenous pacing include increased surgical time, need for sedation for placement, and the lack of clear improved outcome. In a large retrospective review of artificial pacemaker practices and outcomes from seven veterinary institutions, the use of temporary transvenous pacing in patients undergoing permanent pacing varied from 4% to 100%, depending on the institution and personnel performing the procedure.4 No complications from temporary cardiac pacing were reported in this case cohort. Complications, in general, from cardiac pacing were related primarily to the operator’s experience level and frequency in placing artificial pacemakers.


Temporary transvenous cardiac pacing is the preferred modality in humans.1,2 Advantages of the transvenous system, as compared with transcutaneous pacing, include more consistent capture, improved patient comfort, and relative ease of insertion by experienced personnel. In the veterinary arena, temporary transvenous pacing usually is available only at university or private specialty hospitals.



INDICATIONS FOR TEMPORARY TRANSVENOUS PACING


Indications for temporary transvenous pacing follow:


1 Support of heart rate and blood pressure is provided by temporary transvenous pacing while the patient is under general anesthesia during permanent pacemaker implantation.

2 A patient with medically refractory bradycardia that is in eventual need of a permanent pacemaker and requires hemodynamic support needs temporary pacing. Some of these patients are being stabilized until permanent pacemaker implantation is possible (e.g., personnel issues). Other patients may have systemic infection or endocarditis; thus permanent pacemaker implantation is being postponed until the patient is free of infection.

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  3. Ventilator-Associated Lung Injury
  4. Allergic Airway Disease in Dogs and Cats and Feline Bronchopulmonary Disease

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Sep 10, 2016 | Posted by in SMALL ANIMAL | Comments Off on Temporary Transvenous Pacing

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