The Applications Of Transcutaneous Temporary Pacemakers In Patients With Bradyarrhythmia During Perioperative Period

Objective: To evaluate the feasibility and safety of transcutaneous temporary pacemakers in patients with bradyarrhythmia during perioperative period.Methods: 36 patients with bradyarrhythmia who had underwent noncardiac surgery were selected,the results of dynamic electrocardiography showed the R-R interval or cardiac arrest with 2-3s.They were randomly divided into the observation group of transcutaneous pacemaker(TCP,group C,n = 20)and the control group of transvenous pacemaker(TVP,group V,n = 16).SBP and DBP with pacing rate of 70 beats/min and50 beats/min were observed in two group.Systolic blood pressure(SBP)and diastolic blood pressure(DBP)and heart rate(HR)were recorded before anesthesia(T0),5 min after induction(T1),5 min after skin incision(T2),30 min after skin incision(T3)and 60 min after operation(T4),and recorded the results of troponin I and myoglobin on the first day after operation.Hemodynamic changes,pacing effect and postoperative complications were compared between the two groups.Results:1.Based on the general information: there were no statistical significance on the difference in age,sex,arrhythmia type,operation type,proportion of patients with hypertension and coronary heart disease between the two groups(P>0.05).2.Based on the SBP and DBP at different pacing rates: SBP and DBP at pacing rate of 50 beats/min were higher than 70 beats/min,and there were significant difference in the results between the two groups(P<0.05).3.Based on the hemodynamic parameters at T0,T1,T2,T3 and T4,there were no significant difference in SBP,DBP and HR between the two groups(P>0.05).4.Based on the pacemaker implantation and working condition: In group V,there were two patients with pacemaker dysfunction before anesthesia induction(One patient had pacemaker heart rate fell off,the pacemaker works abnormally in one patient).5 patients had needed continuously pacing,10 patients had needed intermittent pacing and 1 patient had not needed pacing during the operation.In group C,the pacemaker worked normally before anesthesia induction.During the operation,1 patient were needed continuously pacing,13 patients were needed intermittent pacing and 6patients were not needed pacing.There were no significant difference in the need of pacemaker working between the two groups(P>0.05).5.Based on the troponin I and myoglobin: the results of troponin I were <0.02ng/ml and myoglobin were<61ng/ml,and there were no significant difference in the results between the two groups(P>0.05).6.Based on the postoperative complications and outcomes: One patient developed lower limb deep phlebothrombosis in group V,and there was no skin burn,skeletal muscle,myocardial injury and other complications in group C.All patients were safe in perioperative period and recovered well without death.7.Based on the pacing cost and operation waiting time: the pacing cost was 1886 yuan in group V and 475 yuan in group C.There were no significant difference in operation waiting time between the two groups(P>0.05).Conclusions:In patients with bradyarrhythmias undergoing noncardiac surgery,TCP and TVP have the same effect,which can keep hemodynamics steady and reduce the perioperative risk of patients,but TCP is simple and fast,and could reduce the trauma of patients,reduce hospital costs.