Outcomes of Standard Permanent Active Fixation Leads for Temporary Pacing

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Increasing incidence of cardiac implantable electronic device infections necessitates transvenous lead extraction (TLE).
• Pacemaker-dependent patients require temporary pacing post-TLE, but data on Temporary Pacing via an Externalized Active-Fixation (TPEAF) leads are limited.

Purpose of the Study:

• To evaluate the safety and efficacy of TPEAF leads in pacemaker-dependent patients following TLE.

Main Methods:

• Retrospective evaluation of 158 patients implanted with TPEAF leads post-TLE between April 2004 and December 2017.
• Analysis of procedural and post-implantation complications, including lead dislodgement, pacing thresholds, and infections.
• Assessment of patient outcomes, including mortality during hospitalization.

Main Results:

• A total of 158 TPEAF leads were placed in patients with a mean age of 74 years.
• Procedural complications occurred in 2.5% of patients (cardiac arrest, tamponade, bleeding).
• Post-implantation complications occurred in 8.2% (lead dislodgement in 8, vegetations in 2, pneumothorax in 1, loss of capture in 1). Lead dislodgements predominantly occurred within 24 hours.
• Sixteen patients (10.1%) died during hospitalization due to various causes including septic shock and cardiac arrest.

Conclusions:

• Temporary Pacing via an Externalized Active-Fixation (TPEAF) leads demonstrate safety and efficacy in pacemaker-dependent patients after transvenous lead extraction.
• Lead dislodgement is a significant risk, particularly within the first 24 hours post-implantation.
• Persistent fever and positive blood cultures warrant investigation for potential vegetation on the temporary lead.