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

Objectives: Insertion of a temporary transvenous pacemaker (TTPM) is one of the life-saving interventions performed in the emergency department (ED). The aim of the study was to determine demographic, clinical characteristics, and in-hospital outcomes of patients who underwent TTPM insertion due to hemodynamically unstable bradyarrhythmia in the ED.
Methods: In our study, 234 consecutive patients who underwent TTPM insertion at the bedside in the ED between January 2014 and October 2019 were included in the study. Etiological characteristics, electrocardiographic (ECG) findings, requirements for permanent pacemaker (PPM), and in-hospital mortality of the patients were analyzed retrospectively.
Results: Extrinsic causes were the most common etiology of unstable bradyarrhythmia (57.6%). Most extrinsic causes were drug therapy-related factors (60.7%). Bradyarrhythmia persisted in 60% of patients after extrinsic causes were eliminated. The most common ECG finding was a high-degree atrioventricular block (62%). PPM was implanted in 44% of patients. In-hospital mortality rate was 19.7%. In the multivariate regression analysis, the left ventricular ejection fraction (LVEF) and diastolic blood pressure (DBP) measured at admission (p<0.001 and p<0.001, respectively) were determined to be independent predictors for in-hospital mortality.
Conclusion: First diagnosis and intervention in the ED are of great importance for patients with unstable bradyarrhythmia. The fastest possible TTPM insertion in the ED can reduce mortality by reducing the exposure time to hypoperfusion of vital organs, especially in patients with reduced LVEF and low DBP. Furthermore, it should be kept in mind that an underlying latent conduction system disease can also be present in bradyarrhythmias thought to occur potentially due to extrinsic factors.

Acil Serviste Yatak Baþý Geçici Transvenöz Kalp Pili Takýlmasý: Tek Merkez Deneyimi

Amaç: Geçici transvenöz pacemaker (GTPM) takýlmasý, acil serviste (AS) uygulanan hayat kurtarýcý müdahalelerden biridir. Bu çalýþmanýn amacý, acil serviste hemodinamik açýdan stabil olmayan bradiaritmi nedeniyle GTPM takýlan hastalarýn demografik, klinik özelliklerini ve hastane içi sonuçlarýný belirlemekti.
Yöntem: Çalýþmamýza Ocak 2014 ve Ekim 2019 tarihleri arasýnda, ASʼde yatak baþý GTPM takýlan ardýþýk 234 hasta dahil edildi. Hastalarýn etiyolojik özellikleri, elektrokardiyografi
(EKG) bulgularý, kalýcý pacemaker (KPM) gereksinimleri ve hastane içi mortalite geriye dönük olarak incelendi.
Bulgular: Stabil olmayan bradiaritmilerin en sýk etiyolojisi ekstrinsik nedenlerdi (%57,6). Ekstrinsik etyolojilerin çoðunluðu ilaç tedavisiyle iliþkili faktörlerdi (%60,7). Bradiaritmi, ekstrinsik nedenler ortadan kaldýrýldýktan sonra hastalarýn %60'ýnda devam etti. En sýk EKG bulgusu yüksek dereceli atrioventriküler bloktu (%62). Hastalarýn %44ʼüne KPM implante edildi. Hastane içi mortalite oraný %19,7 idi. Çok deðiþkenli regresyon analizinde sol ventrikül ejeksiyon fraksiyonu (LVEF) ve baþvuru anýnda ölçülen diyastolik kan basýncý (DKB) (p<0,001; p<0,001, sýrayla) hastane içi mortalitenin baðýmsýz öngörücüleri olarak belirlendi.
Sonuç: Acil serviste ilk taný ve müdahale stabil olmayan bradiaritmili hastalar için büyük önem taþýmaktadýr. Acil serviste mümkün olan en hýzlý þekilde GTPM takýlmasý özellikle düþük LVEF’li ve düþük DBP'li hastalarda hayati organlarýn hipoperfüzyonuna maruz kalma süresini azaltarak mortaliteyi azaltabilir. Ayrýca, potansiyel olarak dýþ faktörlere baðlý olarak ortaya çýktýðý düþünülen bradiaritmilerde de altta yatan bir latent iletim sistemi hastalýðý olabileceði akýlda tutulmalýdýr. (SETB-2021-02-059)