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[Perioperative temporary pacemaker therapy]
László Szudi1, Erzsébet Paulovich, Zsolt Faluvégi
1Tolna megyei Onkormányzat Kórháza, Szekszárd, Aneszteziológiai Osztály.
Insights
Elective temporary pacing guidelines are debated, especially for first-degree AV block. Transcutaneous pacing is a readily available option for perioperative bradyarrhythmias when other methods are not feasible.
Area of Science:
- Cardiology
- Anesthesiology
- Electrophysiology
Context:
- Perioperative management of heart block lacks standardized guidelines for elective temporary pacing.
- First-degree atrio-ventricular block with bifascicular or left bundle branch block presents a debated indication for pacing.
- Sudden onset of complete atrio-ventricular block during surgery can occur without prior ECG abnormalities.
Purpose:
- To review and compare different temporary pacing methods (transvenous, transcutaneous, transesophageal) for perioperative use.
- To summarize the advantages, disadvantages, and complication prevention strategies for each pacing technique.
- To inform decision-making regarding elective perioperative temporary pacing based on patient condition and procedural factors.
Summary:
- The review covers various temporary pacing modalities, detailing their pros and cons.
- Considerations for method selection include patient status, concurrent treatments, surgical plan, and staff expertise.
- Transcutaneous pacing is highlighted as an accessible, low-experience-required option, potentially bridging until transvenous lead placement.
Impact:
- Aims to improve perioperative cardiac care by clarifying temporary pacing options.
- Facilitates informed choices in managing emergent bradyarrhythmias during surgery.
- Emphasizes the practical utility of transcutaneous pacing in operating room settings.
Introduction:
Numerous factor can precipitate progression of incomplete heart block to complete heart block in the perioperative period. While there is a consensus of the indications of acute temporary pacing, there is no widely accepted guidelines for the elective perioperative temporary pacing. The indications are clear in the cases of second or third degree atrio-ventricular block, bradycardias, bradyarrhythmias with frequency less than 50/min not responding to atropine, but there are many debate in the cases of first degree atrio-ventricular block with bifascicular or left bundle branch block. Furthermore, during the operation bradyarrhythmia, complete atrio-ventricular block not responding to atropine can develop without any sign on the previous ECG at rest.
Methods And Results:
The authors review the different methods of pacing (transvenous, transcutaneous, transoesophageal), summarize the advantages and disadvantages of each method, the complications and their prevention. Patients' condition, concomitant medical treatment, designed procedures and staffs' experience in the introduction of pacemaker electrode must be considered in questioned cases.
Conclusions:
The transcutaneous method is easily performed, don't need a lot of experience. It must be available in every operating theatre and in the questioned cases may be enough until the introduction of the transvenous electrode, if the field of operation make the electrode placement possible.