Echocardiography-guided versus fluoroscopy-guided temporary pacing in the emergency setting

Abstract

The insertion of a temporary pacemaker can be a lifesaving procedure in the emergency setting. This is an observational monocentric study comparing echocardiography-guided temporary pacemaker via the right internal jugular vein to standard fluoroscopy-guided temporary pacemaker via the femoral vein; the procedure was tested for noninferiority. Patients needing urgent pacing were consecutively enrolled. Primary efficacy endpoints were time to pacing and need for catheter replacement. Primary safety endpoint was a composite outcome of overall complications. One hundred and six patients (77 ± 10 years) were enrolled: 53 underwent echocardiographic-guided and 53 fluoroscopy-guided temporary pacemaker. Baseline characteristics of the two groups of treatment were similar. Time to pacing was shorter in the echocardiography-guided than in the fluoroscopy-guided group (439 ± 179 vs. 716 ± 235 s; P<0.0001; power 100%). During the pacing (54 ± 35 h), there was a higher incidence of pacemaker malfunction in the fluoroscopy-guided group [15 vs. 3 patients; odds ratio (OR) 6.5, confidence interval (CI) 95% 1.9-29.7, P<0.001; power 5.7%] and there was a significantly lower incidence of complications in the echocardiography-guided temporary pacemaker group (6 vs. 22 patients; OR 0.18, CI 95% 0.06-0.49, P<0.001; echocardiography-guided temporary pacemaker events rate 0.1929 vs. fluoroscopy-guided temporary pacemaker events rate 1.398 per 100 person-hours paced, P<0.0001). In the standard group there was one death attributable to a temporary pacemaker complication (sepsis). Echocardiography-guided temporary pacemaker is a well-tolerated procedure that could allow reliable insertion of a temporary pacemaker; therefore, it is a well-tolerated option in an emergency setting and in hospitals where fluoroscopy is not available.