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Echocardiography-guided versus fluoroscopy-guided temporary pacing in the emergency setting: an observational study

Pinneri, Francesco; Frea, Simone; Najd, Kamal; Panella, Silvana; Franco, Erica; Conti, Valentina; Corgnati, Giuditta

Journal of Cardiovascular Medicine: March 2013 - Volume 14 - Issue 3 - p 242–246
doi: 10.2459/JCM.0b013e32834eecbf
Original articles
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Background The insertion of a temporary pacemaker can be a lifesaving procedure in the emergency setting.

Objectives This is an observational monocentric study comparing echocardiography-guided temporary pacemaker via the right internal jugular vein to standard fluoroscopy-guided temporary pacemaker via the femoral vein; the procedure was tested for noninferiority.

Methods Patients needing urgent pacing were consecutively enrolled. Primary efficacy endpoints were time to pacing and need for catheter replacement. Primary safety endpoint was a composite outcome of overall complications.

Results One hundred and six patients (77 ± 10 years) were enrolled: 53 underwent echocardiographic-guided and 53 fluoroscopy-guided temporary pacemaker. Baseline characteristics of the two groups of treatment were similar. Time to pacing was shorter in the echocardiography-guided than in the fluoroscopy-guided group (439 ± 179 vs. 716 ± 235 s; P < 0.0001; power 100%). During the pacing (54 ± 35 h), there was a higher incidence of pacemaker malfunction in the fluoroscopy-guided group [15 vs. 3 patients; odds ratio (OR) 6.5, confidence interval (CI) 95% 1.9–29.7, P < 0.001; power 85.7%] and there was a significantly lower incidence of complications in the echocardiography-guided temporary pacemaker group (6 vs. 22 patients; OR 0.18, CI 95% 0.06–0.49, P < 0.001; echocardiography-guided temporary pacemaker events rate 0.1929 vs. fluoroscopy-guided temporary pacemaker events rate 1.398 per 100 person-hours paced, P < 0.0001). In the standard group there was one death attributable to a temporary pacemaker complication (sepsis).

Conclusion Echocardiography-guided temporary pacemaker is a well-tolerated procedure that could allow reliable insertion of a temporary pacemaker; therefore, it is a well-tolerated option in an emergency setting and in hospitals where fluoroscopy is not available.

aDivision of Cardiology, Internal Medicine Department, Ospedale Civico di Chivasso

bDivision of Cardiology, Internal Medicine Department, AOU S. Giovanni Battista ‘Molinette’ di Torino and University of Torino, Torino, Italy

Correspondence to Francesco Pinneri, S.C. Cardiologia, Ospedale Civico di Chivasso, ASL TO 4, Corso Galileo Ferraris 3, 10034, Chivasso, Torino, ItalyTel: +39 119 176 287; fax: +39 119 176 410; e-mail: pinnerif@libero.it

Received 9 February, 2011

Revised 7 October, 2011

Accepted 5 November, 2011

© 2013 Italian Federation of Cardiology. All rights reserved.