Temporary Permanent Pacemaker?

The term Temporary Permanent Pacemaker will seem to be a contradiction of terms, but it is a reality! One of the earliest reports of using temporary permanent pacemaker was in the setting of an infected cardiac implantable electronic device (CIED) in a pacemaker dependent patient. In such a patient, a temporary pacemaker wire may be required for long periods during antibiotic treatment. During this period, loss of capture and under sensing are common over the time with temporary pacemaker wires and patient mobility is restricted. It was in this situation that an externalized permanent active-fixation pacemaker lead connected to a permanent pacemaker generator for temporary pacing was implemented. It has the benefit of improved lead stability and greater patient mobility as well as comfort.

In that report, of the 47 patients who underwent lead extraction for CIED infection over a two year period, 23 were pacemaker dependent and underwent temporary permanent pacemaker implantation. A permanent pacemaker lead was implanted in the right ventricle via the internal jugular vein and connected to pulse generator, which was secured externally at the base of the neck. Usage period was 3 to 45 days, with a median usage of 18 days, without loss of capture or sensing failure in any patient. Twelve patients were either discharged home or to a nursing facility with the temporary permanent pacemaker until completion of antibiotic treatment and re-implantation of a new permanent pacemaker [1].

A recent retrospective chart review study of 126 patients who underwent temporary pacing compared temporary permanent pacing with balloon tipped temporary pacing between 2014 to 2022. Both groups had similar baseline charcteristics. Subclavian vein was the most common site of access for the temporary permanent pacemaker cohort, while it was femoral vein for the balloon tipped temporary pacemaker group. As expected, ambulation was possible only in the temporary permanent pacemaker group, that too in 55.6% only. Lead dislodgement, venous thromboembolism, local hematoma and access site infections were less frequently encountered in the temporary permanent pacemaker group. 36.6% of the temporary permanent pacemaker group were monitored outside the ICU setting. There was no significant difference in the pacemaker related adverse events among temporary permanent pacemaker patients based on their in-hospital setting [2].

References

1. Kawata H, Pretorius V, Phan H, Mulpuru S, Gadiyaram V, Patel J, Steltzner D, Krummen D, Feld G, Birgersdotter-Green U. Utility and safety of temporary pacing using active fixation leads and externalized re-usable permanent pacemakers after lead extraction. Europace. 2013 Sep;15(9):1287-91. doi: 10.1093/europace/eut045. Epub 2013 Mar 12. PMID: 23482613.
2. Chedid M, Shroff GR, Iqbal O, Adabag S, Karim RM. Temporary-permanent pacemakers are associated with better clinical and safety outcomes compared to balloon-tipped temporary pacemakers. Pacing Clin Electrophysiol. 2024 Feb;47(2):203-210. doi: 10.1111/pace.14918. Epub 2024 Jan 19. PMID: 38240391.