| Objective: This study aimed to explore the feasibility and safety of performing temporary cardiac pacing via the femoral vein with an active fixed pacing lead.Methods:Patients aged more than 14 years old who were hospitalized in Guilin People’s Hospital from July 1,2019,to January 31,2021,with indications for temporary cardiac pacing were included in this study.The patients who met the exclusion criteria were excluded.After perfecting the preoperative preparation,temporary cardiac pacing via the femoral vein was performed using an 85 cm long Medtronic active fixed pacing lead.The temporary pacing leads were removed after the patients reached the lead removal standard after the operation.The patient’s clinical baseline data such as age,gender,indications for temporary pacing,and underlying diseases,the intraoperative observational data such as pacing parameters,procedure duration,and X-ray exposure dose,the efficacy and safety data such as the indwelling duration of the pacing electrode,clinical outcomes,and complications were extracted respectively.Patients who underwent operations named "Temporary Transvenous Pacemaker System Implantation" with ICD-9-CM-3 code as "37.78" in Guilin People’s Hospital from September 1,2012,to June 30,2019,were searched and extracted.Patients aged more than 14 years old who underwent temporary cardiac pacing using passive fixed pacing leads via the femoral vein or using active fixed pacing leads via the subclavian veins were included in our retrospective survey.The patients who met the exclusion criteria were excluded.In our observational study,patients who underwent temporary cardiac pacing therapies via the femoral veins using active fixed leads were classified as group A.In our retrospective survey,patients who underwent temporary cardiac pacing therapies via the subclavian veins using active fixed pacing leads were classified as group B,and those who underwent temporary cardiac pacing therapies via the femoral veins using passive fixed pacing leads were classified as group C.The clinical baseline data,the intraoperative observational data,and the efficacy and safety data of the patients in the three groups were recorded and compared.Results: A total of 25 patients who underwent temporary cardiac pacings via the femoral veins using active fixed pacing leads were reported in this study(group A).The average age of patients in group A was 66.8 ± 13.7 years,while the average height of patients was 159.3 ± 6.5 cm.The distal ends of the temporary cardiac pacing leads were located at the septums of the right ventricular inflow tract in 24 cases and the septums of the right ventricular outflow tract in one case.The pacing threshold tested during the procedure was0.6(0.5,1.0)V,the R wave amplitude was 8.0(6.7,11.2)m V,the lead impedance was 746.2 ± 113.0 Ω,and the procedure duration was 46.8 ± 7.3 min.The lead’s length outside the puncture point was 27.0(26.0,29.4)cm,and the X-ray exposure dose was 15.3 ± 3.0 m Gy.The pacing parameters re-measured24 h after operations were similar to those measured during the operations(p >0.05).The clinical outcomes were as follows: permanent pacemakers were implanted in 19 cases,heart rate returned to normal in 5 cases,in-hospital death occurred in one case with no causal connection with temporary cardiac pacing,and none of the 25 cases had any procedural complications.In our retrospective survey,a total of 47 patients were enrolled in group B,and 49 patients were enrolled in group C.The clinical baseline characteristics of patients in group A,group B,and group C were similar.The average pacing threshold and the R wave amplitude measured during the procedures were similar in group A,group B,and group C.There was no significant difference in the procedure duration and X-ray exposure dose among the three groups(p > 0.05).The average lead impedance measured during the procedures in group A was higher than that of in group B(746.2 ± 113.0 Ω vs.645.5 ± 137.6 Ω,p < 0.01)and group C(746.2 ±113.0 Ω vs.516.0 ± 145.0 Ω,p < 0.001).The clinical outcomes of the three groups of patients were not significantly different(p > 0.05).None of the 25 patients in group A had any complications.In comparison,two complications occurred in the 47 patients in group B,including one case of postoperative lead dislodgment and one case of pneumothorax.There was no significant difference in the incidence rate of complication between group A and group B(p > 0.05).In group C,12 cases occurred complications,of which 11 occurred postoperative lead dislodgment,and one case showed poor perception.The incidence rates of overall complication and postoperative lead dislodgment in group C were significantly higher than those in group A and group B(p < 0.05).Although the average cost of temporary pacing surgery in group A and group B was higher than the cost in group C,the immobilization duration of the lower extremity on the operating side and time spent in the intensive care unit in group A and group B were significantly shorter than those in group C(p < 0.001).Therefore,there was no significant difference in total cost related to temporary cardiac pacing among the three groups(p = 0.498).Conclusions:(1)It is feasible and safe to use an active fixed pacing lead for temporary cardiac pacing via the femoral vein.(2)Compared with the traditional application of passive fixed leads for temporary cardiac pacings via the femoral veins,using active fixed leads for temporary cardiac pacings via the femoral veins has a lower lead dislodgment rate,possibly was safer and more reliable with a higher economic benefit ratio.(3)The efficacy and safety of using active fixed pacing leads for temporary cardiac pacings via the femoral veins are not inferior to using active fixed pacing leads for temporary cardiac pacing via the subclavian veins.(4)Using active fixed pacing leads for temporary cardiac pacings via the femoral veins may be more suitable for some special populations.It can be used as a beneficial supplement to traditional temporary cardiac pacing. |
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