Bedside Temporary Transvenous Pacemaker Insertion in the Emergency Department: A Single-Center Experience

Area of Science:

• Emergency Medicine
• Cardiology
• Critical Care

Background:

• Temporary transvenous pacemaker (TTPM) insertion is a critical intervention in the emergency department (ED) for hemodynamically unstable bradyarrhythmia.
• Understanding patient characteristics and outcomes is vital for optimizing emergency care.

Purpose of the Study:

• To determine the demographic and clinical characteristics of patients requiring TTPM insertion in the ED.
• To analyze the in-hospital outcomes, including permanent pacemaker (PPM) implantation and mortality rates, associated with TTPM use.

Main Methods:

• Retrospective analysis of 234 consecutive patients who underwent bedside TTPM insertion in the ED.
• Evaluation of etiological factors, electrocardiographic (ECG) findings, and subsequent need for PPM.

Main Results:

• Extrinsic causes, primarily drug-related, were the most common etiology (57.6%).
• High-degree atrioventricular block was the most frequent ECG finding (62%).
• 44% of patients received a permanent pacemaker (PPM), and the in-hospital mortality rate was 19.7%. Left ventricular ejection fraction (LVEF) and diastolic blood pressure (DBP) were independent predictors of mortality.

Conclusions:

• Early diagnosis and intervention in the ED are paramount for managing unstable bradyarrhythmia.
• Rapid TTPM insertion can mitigate mortality by reducing organ hypoperfusion, particularly in patients with reduced LVEF and low DBP.
• The possibility of underlying conduction system disease should be considered even when bradyarrhythmia appears to stem from extrinsic factors.