Temporary Endocavitary Pacemakers and their Use and Misuse: the Least is Better
- Antoine Kossaify
- Clinical Medicine Insights. Cardiology
BACKGROUND To evaluate contemporary trends of clinical characteristics, etiologies, and underlying diseases, and their relationship between different bradyarrhythmias in patients undergoing temporary pacemakers (TPMs). METHODS This study included 509 patients (77 ± 11 year, 74% males) with symptomatic bradyarrhythmias requiring TPMs between 2002 and 2008. Demographics, electrocardiographic indications, etiologies, underlying diseases, and the outcome of permanent pacemaker (PPM) implants within 30 days were analyzed. RESULTS Atrioventricular conduction dysfunction (AVCD) (64.0%) dominated in all bradyarrhythmias, with idiopathic degeneration (61%) as its major etiology. Antiarrhythmic drug (38%) was the leading cause in sinoatrial node dysfunction (SAND). There was an increasing trend in AVCD, while a decreasing trend in SAND. Regarding etiologies for TPM, an increasing trend was found in idiopathic degeneration, whereas a decreasing trend in acute coronary syndrome (ACS). Idiopathic degeneration had an odds ratio (OR) of 1.9 for AVCD (P = 0.001), whereas electrolyte/acid-base disturbances (OR = 3.7, P = 0.001), β-blockers (OR = 2.4, P = 0.002), and chronic renal disease (OR = 1.9, P = 0.01) were associated with SAND. Patients with intrinsic etiologies for TPM had a high incidence of PPM implantation within 30 days than those with extrinsic causes (67.5% vs 3.8%, P < 0.0001) CONCLUSION Increasing trends in patients requiring TPMs were observed in the elderly patients and those with AVCD and idiopathic degeneration, while decreasing trends were observed in those with SAND and ACS. Idiopathic degeneration was associated with AVCD, whereas extrinsic etiologies were related to SAND. Patients with intrinsic etiologies had a higher incidence of PPM implantation than those with extrinsic factors for TPM.