Temporary Transvenous Pacing Performed in the Intensive Care Unit or in the Catheterization Laboratory

Temporary transvenous pacing (TTP) is a common procedure, predominantly performed in the catheterization laboratory (cath lab) because of presumed lower complication rate. This study aims to evaluate the efficacy and safety of TTP placement in the ICU compared to TTP placement in the cath lab.

This retrospective, real-life study included all patients requiring TTP in a tertiary care ICU between 2019 and 2022. Patients' characteristics, TTP-related data, outcomes, and complications were compared between groups (ICU vs. cath lab).

Data from 193 patients receiving TTP were analyzed; 68.4% received TTP in the ICU and 31.6% in the cath lab. The main indication was atrioventricular block in 154 patients (79.8%). The operator was less frequently an interventional cardiologist in the ICU (12.1%) compared to the cath lab (100%, p < 0.001). TTP in the ICU was more frequently performed using a jugular access (72.0% vs. 1.6%), a right-sided laterality (88.7% vs. 43.6%), and a balloon-tipped catheter (100% vs. 0%, p < 0.001 for all comparisons). Success was 100% in both groups. The overall complication rate was 16.6%, with no significant difference between both groups (14.4% ICU vs. 21.3% cath lab, p = 0.13), but a tendency toward higher complications in the cath lab group (especially tamponade, lead displacement, and CIED infection).

In a daily clinical scenario, TTP placement appears as safe in the ICU than in the cath lab, regardless of the operator's level of expertise when performed in accordance with best practices. Nevertheless, TTP complications remain high, and alternatives should be used whenever possible.