[Efficacy and safety of non-permanent transvenous pacemaker implantation in an intensive care unit]

Abstract

Objective: To analyze the clinical indications for use, morbidity and mortality associated with a non-permanent transvenous pacemaker.

Design: Prospective and observational study.

Setting: Cardiac intensive care unit.

Method: One hundred and eighty-two patients with non-permanent pacemakers implanted consecutively over a period of four years.

Data collected: Main variables of interest were demographic data, clinical indications, access route, length of stay and complications.

Results: A total of 63% were men, with a median age of 78 ± 9.5 years and with symptomatic third-degree atrioventricular block in 76.9% of the cases. Femoral vein access was preferred in 92.3% of the cases. Complications appeared in 40.11% of the patients, the most frequent being hematoma at the site of vascular access (13.19%). Restlessness was associated to the need for repositioning the pacemaker due to a shift in the electrode (p=0.059) and to hematoma (p=0.07). Subclavian or jugular vein lead insertion (p=0.012; OR=0.16; 95%CI, 0.04-0.66), restlessness during admission to ICU (p=0.006; OR=3.2; 95%CI, 1.4-7.3), and the presence of cardiovascular risk factors (p=0.042; OR=5; 95%CI, 1.06-14.2) were identified by multivariate analysis as being predictors of complications. Length of stay in ICU was significantly longer when lead insertion was carried out by specialized staff (p=0.0001), and in the presence of complications (p=0.05).

Conclusions: Predictfurors of complications were restlessness, cardiovascular risk factors, and insertion through the jugular or subclavian vein. Complications prolonged ICU stay and were not related to the professionals involved.