Background: Temporary-permanent (T-P) pacemakers can serve as safe short-term pacing options in multiple clinical settings. We use this technique frequently and report our experience, outcomes, and clinical settings where they are useful.
Methods: 42 consecutive patients, [32 M/10 F, mean age 68 yr. (20-98 yr.)] who received a T-P at our center in the last 12 months were studied. Mean procedure time was 45 ± 31 min. Devices were single-chamber, dual-chamber, one bi-ventricular (LV/RV), and an ICD - using a dual coil lead and programming appropriately. Implant duration ranged from 1-40 days (mean 16.2). There were no complications.
Results: Bradycardia was the most common indication [18 pts] followed by need for pacing following lead extraction during treatment of active infection [14 pts]. “Pacemaker test-drive” in Sick Sinus Syndrome when either the doctor or patient aren’t convinced a pacemaker is needed was done in 5 of the 18 bradycardic pts. Pacing with active sepsis [1 pt] where permanent implantation is not feasible, pacing in cardiogenic shock [3 pts] and pacing during peri-procedural period of TAVR or surgical aortic valve replacement [3 pts] are other indications. One pt had uncontrollable AF and was failing all treatments. He was infected, so we implanted a bi-v T-P and ablated his AV node which enabled him to be hemodynamically stabilized and off pressors. Eventually he received a permanent device. One woman had metastatic carcinoma and symptomatic 10-15 second pauses in AF. She received a T-P as a comfort measure and she expired six weeks post-implant from her disease. Of the 42 implanted devices, 68% were converted to permanent devices. 5 pts died prior to hospital discharge from underlying issues.
Conclusion: T-P are safe, easily implanted and provide stable temporary pacing options in varied acute clinical settings. They provide physiologic pacing using active-fixation lead(s) and a device with rate-responsive modes. The subclavian approach is more comfortable than an internal jugular lead. By placing a waterproof dressing over the device, patients can continue their normal activities as an outpatient. This is an underutilized technique and our data may encourage increased use of this cost-effective technique.