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Cardiac tamponade caused by temporary right ventricular (RV) pacemaker perforation is a rare but serious complication in transcatheter aortic valve replacement (TAVR). To study the incidence of temporary pacemaker related cardiac tamponade in TAVR, and the relation to the type of pacemaker lead used in periprocedural temporary transvenous pacing. A single center registry of transfemoral TAVRs in 2014–2020. Main inclusion criterion was peri-operative use of a temporary RV pacing lead. Main exclusion criteria were a preoperatively implanted permanent pacemaker or the exclusive use of left ventricular guidewire pacing. Incident cardiac tamponade was classified as pacemaker lead related, or other. Patients were grouped according to type of temporary RV pacing wire. 810 patients were included (age 80.5 ± 7.3 [mean ± standard deviation], female 319, 39.4%). Of these, 566 (69.9%) received a standard RV temporary pacing wire (RV-TPW), and 244 (30.1%) received temporary RV pacing through a permanent, passive pacemaker lead (RV-TPPL). In total, 18 (2.2%) events of cardiac tamponade occurred, 12 (67%) were pacemaker lead related. All pacemaker lead-related cardiac tamponades occurred in the group who received a standard RV-TPW and none in the group who received RV-TPPL (n = 12 [2.1%] vs. n = 0 [0%], p = 0.022). No difference in cardiac tamponade due to other causes was seen between the groups (p = 0.82). The use of soft-tip RV-TPPL was associated with a lower risk of pacemaker related cardiac tamponade in TAVR. When perioperative pacing is indicated, temporary RV-TPPL may contribute to a significant reduction of cardiac tamponade in TAVR. • A subset of TAVR patients need stable, peri-operative temporary right ventricular pacing. • Standard temporary pacing wires may perforate and cause tamponade. • Incident tamponade was 2.1% with standard temporary RV pacing. • Temporary pacing with permanent, passive pacemaker leads significantly reduced tamponade risk. [ABSTRACT FROM AUTHOR]

In-hospital delays in permanent cardiac pacemaker (PPM) implantation are common and may result in in-hospital infection among patients waiting for PPM implantation (pre-PPM-HI). This study investigated the predictors and prognostic impact of these events. We retrospectively evaluated 905 consecutive patients (68.2 ± 16.0 years; 54% males) who underwent PPM implantation. Clinical characteristics, pre-PPM-HI and 30-day mortality were recorded and a risk score for pre-PPM-HI was generated using multivariable logistic regression coefficients. Eigthy-nine patients (10% of the sample) developed pre-PPM-HI. Multivariable logistic regression analysis identified urinary catheter use, complete atrioventricular block, implantation of temporary pacemaker and diabetes mellitus as independent predictors of pre-PPM-HI. The generated score (range 0–10.1) played a better role in predicting pre-PPM-HI than individual factors, yielding an area under the curve [95%CI] of 0.754 [0.705–0.803]. Patients with score ≥ 7.5 had 18-fold greater risk of developing pre-PPM-HI than those with score < 2.5. Furthermore, multivariable Cox-regression analysis showed that patients who developed pre-PPM-HI had greater 30-day mortality after PPM implantation (hazard ratio [95%CI] = 2.90 [1.18–7.16], p = 0.021) compared with their counterparts. This study reveals that pre-PPM-HI is an independent predictor of early mortality after PPM implantation. In addition, a clinical score developed from simple clinical variables accurately identified patients at high risk of pre-PPM-HI. In scenarios where delays in PPM implantation are unavoidable, such as reference hospitals with high demand, the use of this tool can potentially help in the hierarchy of patients and in the reduction of this adverse event. [Display omitted] • In-hospital infections in patients waiting for permanent cardiac pacemaker (PPM) implantation (pre-PPM-HI) are common. • Determinants and prognostic value of pre-PPM-HI are not established Urinary catheter use, complete AV block, temporary pacing and diabetes mellitus are associated with pre-PPM-HI incidence. • A combined risk score built from these variables had a fair ability to predict the development of pre-PPM-HI. • pre-PPM-HI was independently associated with greater 30-day mortality after PPM implantation. [ABSTRACT FROM AUTHOR]

Background: The placement of a temporary epicardial pacing wire is a challenge during a minimally invasive redo cardiac operation. The aim of this study is to assess the application of temporary endocardial pacing in patients who underwent minimally invasive redo tricuspid surgery.Methods: Perioperative data of consecutive patients who underwent thoracoscopic redo tricuspid surgery were collected. All the tricuspid surgeries and combined procedures were performed under peripheral cardiopulmonary bypass without aortic cross-clamping. A sheath was introduced into the right jugular vein beside the percutaneous superior vena cava cannula and a temporary endocardial pacing catheter was guided into the right ventricle via the sheath prior to the right atrial closure. The pacemaker was connected and run as needed during or after operation.Results: A total of 33 patients who underwent thoracoscopic redo tricuspid surgery were enrolled. Symptomatic tricuspid valve regurgitation (93.9%) and tricuspid valvular prosthesis obstruction (6.1%) after previous cardiac operations were noted as indications for a redo surgery. The mean time from previous cardiac operation to this time redo surgery was 13.3±6.4years. Isolated tricuspid valve replacement was performed in 18 patients (54.5%) and tricuspid valve plasty combined with or without mitral valve replacement was performed in 15 patients (45.5%). A temporary endocardial pacing catheter was successfully placed in the right ventricle for all patients with good sensing and pacing. No temporary pacing related complications occurred from insertion to removal of pacing catheter in the patients.Conclusions: This application of temporary endocardial pacing provided a safe and effective substitute for epicardial pacing in patients who underwent minimally invasive redo tricuspid surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to prospectively reassess the natural evolution and complications of temporary epicardial wires (TEW) after cardiac surgery. Design: Observational prospective study. Setting: Monocentric. Participants: All adult patients having cardiac surgery with TEW insertion, except for those undergoing cardiac transplantation or having permanent pacemakers. Interventions: Thresholds were measured daily until wire removal or permanent device insertion. Descriptive statistics and analysis of variance (ANOVA) were performed with p<0.05 as the significance threshold. Main results: Two hundred thirty-six patients were enrolled. All had ventricular and only 142 (60%) both ventricular and atrial unipolar FEP15, Ethicon TEW. In most TEW (74%), capture thresholds increased significantly by the first (atrial wires) and by the second (ventricular wires) postoperative day and continued to increase until the fifth day, followed by a plateau. For the others, 2 opposite profiles were noticed: 10% of the total TEW lost their capture function before the fourth postoperative day, whereas 16% remained functional beyond the seventh postoperative day. Both atrial and ventricular sensitivity degraded significantly by the second day. The median energy output used for pacing was 17.5 mA (atrial) and 20 mA (ventricular), regardless of the capture thresholds. Major complications related to TEW were noted in 0.8% of cases. Conclusion: Despite widespread use, the natural history of TEW is still a major concern. Pacing with high-energy output is a possible factor leading to capture dysfunction that must be avoided. Education of all operators is needed. [Copyright &y& Elsevier]

Background: Pacemaker-dependent patients with device infection require temporary pacing while the infection is treated. External transthoracic pacing is painful and variably effective, while temporary pacing leads are susceptible to superinfection. Objective: To create a biological pacemaker delivered via venous catheters in a porcine model of complete heart block, providing a temporary alternative/adjunct to external pacing devices without additional indwelling hardware. Methods: Complete atrioventricular (AV) nodal block was induced in pigs by radiofrequency ablation after the implantation of a single-chamber electronic pacemaker to maintain a ventricular backup rate of 50 beats/min. An adenoviral vector cocktail (KAAA + H2), expressing dominant-negative inward rectifier potassium channel (Kir2.1AAA) and hyperpolarization-activated cation channel (HCN2) genes, was injected into the AV junctional region via a NOGA Myostar catheter advanced through the femoral vein. Results: Animals injected with KAAA + H2 maintained a physiologically relevant ventricular rate of 93.5 ± 7 beats/min (n = 4) compared with control animals (average rate, 59.4 ± 4 beats/min; n = 6 at day 7 postinjection; P <.05). Backup electronic pacemaker utilization decreased by almost 4-fold in the KAAA + H2 group compared with the control (P <.05), an effect maintained for the entire 14-day window. In contrast to the efficacy of gene delivery into the AV junctional region, open-chest, direct injection of KAAA + H2 (or its individual vectors) into the ventricular myocardium failed to elicit significant pacemaker activity. Conclusions: The right-sided delivery of KAAA + H2 to the AV junctional region provided physiologically relevant biological pacing over a 14-day period. Our approach may provide temporary, bridge-to-device pacing for the effective clearance of infection prior to the reimplantation of a definitive electronic pacemaker. [Copyright &y& Elsevier]

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Transcutaneous cardiac pacing (TCP) can be used in dogs with a high risk for bradyarrhythmias prior to anesthesia, either in an emergency room or intensive care unit setting. Furthermore, TCP can also be used on patients diagnosed with bradyarrhythmias that require temporary pacing at the induction of anesthesia for the implantation of a permanent pacemaker. Despite the importance of TCP in emergency medicine, no studies have evaluated the optimal size and placement of the transdermal electrodes crucial for the efficacy of TCP in dogs. This study evaluated four different sizes of electrodes (10.5, 20, 30 and 40 cm²), and four different anatomical sites (anterior-posterior, left-right, apex-base, modified left-right) in order to optimize the efficacy of TCP in dogs. Electrodes with a surface area of 20 cm² and a modified left-right placement minimized the pacing current and involuntary skeletal muscular contraction (muscular twitching) and so achieved the most optimal effect of TCP in dogs. [ABSTRACT FROM AUTHOR]

Abstract: Management of severe autonomic dysfunction in patients with Guillain-Barre syndrome (GBS) or its variant Miller-Fisher syndrome (MFS) include placement of permanent pacemaker. We report a case of MFS with severe bradycardia and asystole treated initially with an external permanent (temporary-permanent) pacemaker with a transvenous, active fixation right ventricular lead placement as a “bridge” to permanent pacing. [Copyright &y& Elsevier]