572598 research-article2015
ACC0010.1177/2048872615572598European Heart Journal: Acute Cardiovascular CareFerri et al.
EUROPEAN SOCIETY OF CARDIOLOGY ®
Original scientific paper
Emergent transvenous cardiac pacing using ultrasound guidance: a prospective study versus the standard fluoroscopy-guided procedure
European Heart Journal: Acute Cardiovascular Care 1–5 © The European Society of Cardiology 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872615572598 acc.sagepub.com
Luca A. Ferri, Andrea Farina, Laura Lenatti, Franco Ruffa, GianLuca Tiberti, Luigi Piatti and Stefano Savonitto
Abstract Aims: To compare time to active pacing and complication rates associated with temporary transvenous pacemaker (TTVPM) insertion between a fully echo-guided approach of vein access and lead placement, and standard placement of TTVPM under fluoroscopic guidance. Methods and results: We performed a prospective single-center observational study enrolling all consecutive patients from 1 January 2008 to 31 December 2012 needing emergent TTVPM placement. According to personal experience and clinical setting, the operators could choose between a fully echo-guided approach of TTVPM placement through the jugular vein and a standard fluoro-guided approach through the femoral vein. Safety and efficacy endpoints were pre-specified, registered, and compared. A total of 113 patients were treated using the echo-guided approach, and 90 via the fluoro-guided approach. The two groups differed with regard to clinical setting at presentation: an acute coronary syndrome was more frequent in the fluoro-guided approach group (39.7% vs. 16.8%, p10 procedures vs. >20 procedures) in comparison with the ‘fluoro-guided approach group’ of operators, thus, the lower rate of complications observed in the ‘echo-guided approach group’ should not be ascribed to the different expertise of the operators but, more likely, to the different technique adopted.
Conclusions Fully echo-guided insertion of TTVPM through the jugular vein in emergency settings is a feasible and safe alternative to fluoroscopic guidance in patients that do not need emergent transfer to the cathlab for emergent coronary revascularization. As for all indwelling catheters, for TTVPM placement vein access through the neck should become the standard of care and should be obtained whenever possible.14
Conflict of interest None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Betts TR. Regional survey of temporary transvenous pacing procedures and complications. Postgrad Med J 2003; 79: 463–6. 2. Bjornstad CCL, Gjersten E, Thorup F, et al. Temporary cardiac pacemaker treatment in five Norwegian regional hospitals. Scand Cardiovasc J 2012; 46: 137–43. 3. Gjesdal K, Johansen JB and Gadler F. Temporary emergency pacing: an orphan in district hospitals. Scand Cardiovasc J 2012; 46: 128–30. 4. Birkhahn RH, Gaeta TJ, Tloczkowski J, et al. Emergency Medicine-Trained Physicians are proficient in the insertion of Transvenous Pacemakers. Ann Emerg Med 2004; 43: 469–74. 5. Brignole M, Auricchio A, Baron-Esquivas G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2013; 34:2281–329. 6. Graham AS, Ozment C, Tegtmeyer K, et al. Central Venous Catheterization. N Engl J Med 2007; 356:e21. 7. Aguilera P, Durham BA and Riley DA. Emergency Transvenous Cardiac Pacing Placement Using Ultrasound Guidance. Ann Emerg Med 2000; 36: 224–7. 8. Pinneri F, Frea S, Najd K, et al. Echocardiography-guided versus fluoroscopy-guided temporary pacing in the emergency setting: an observational study. J Cardiovasc Med 2012; 14: 242–6. 9. Leung J, Duffy M and Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med 2006; 48: 540–7. 10. Tsang TS, Enriquez-Serano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002; 77: 429-36. 11. Hodgkiss Harlow K, Back MR, Brumberg R, et al. Technical factors affecting the accuracy of bedside IVC filter placement using intravascular ultrasound. Vasc Endovasc Surg 2012; 46: 293–9. 12. Wen M, Stock K, Heemann U, et al. Agitated Saline BubbleEnhanced Transthoracic Echocardiography: A Novel Method to visualize the Position of Central Venous Catheter. Crit Care Med 2014; 42: e231–3. 13. Francis GS, Williams SV, Achord JL, et al. Clinical competence in insertion of a temporary transvenous ventricular pacemaker. A statement for physicians from the ACP/ ACC/AHA Task Force on Clinical Privileges in Cardiology. Circulation 1994; 89:1913–6. 14. Harrigan RA, Chan TC, Moonblatt S, et al. Temporary transvenous pacemaker placement in the emergency department. J Emerg Med 2007; 1:105–11.
Downloaded from acc.sagepub.com at HOWARD UNIV UNDERGRAD LIBRARY on February 23, 2015
ACC0010.1177/2048872615572598European Heart Journal: Acute Cardiovascular CareFerri et al.
EUROPEAN SOCIETY OF CARDIOLOGY ®
Original scientific paper
Emergent transvenous cardiac pacing using ultrasound guidance: a prospective study versus the standard fluoroscopy-guided procedure
European Heart Journal: Acute Cardiovascular Care 1–5 © The European Society of Cardiology 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872615572598 acc.sagepub.com
Luca A. Ferri, Andrea Farina, Laura Lenatti, Franco Ruffa, GianLuca Tiberti, Luigi Piatti and Stefano Savonitto
Abstract Aims: To compare time to active pacing and complication rates associated with temporary transvenous pacemaker (TTVPM) insertion between a fully echo-guided approach of vein access and lead placement, and standard placement of TTVPM under fluoroscopic guidance. Methods and results: We performed a prospective single-center observational study enrolling all consecutive patients from 1 January 2008 to 31 December 2012 needing emergent TTVPM placement. According to personal experience and clinical setting, the operators could choose between a fully echo-guided approach of TTVPM placement through the jugular vein and a standard fluoro-guided approach through the femoral vein. Safety and efficacy endpoints were pre-specified, registered, and compared. A total of 113 patients were treated using the echo-guided approach, and 90 via the fluoro-guided approach. The two groups differed with regard to clinical setting at presentation: an acute coronary syndrome was more frequent in the fluoro-guided approach group (39.7% vs. 16.8%, p10 procedures vs. >20 procedures) in comparison with the ‘fluoro-guided approach group’ of operators, thus, the lower rate of complications observed in the ‘echo-guided approach group’ should not be ascribed to the different expertise of the operators but, more likely, to the different technique adopted.
Conclusions Fully echo-guided insertion of TTVPM through the jugular vein in emergency settings is a feasible and safe alternative to fluoroscopic guidance in patients that do not need emergent transfer to the cathlab for emergent coronary revascularization. As for all indwelling catheters, for TTVPM placement vein access through the neck should become the standard of care and should be obtained whenever possible.14
Conflict of interest None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Betts TR. Regional survey of temporary transvenous pacing procedures and complications. Postgrad Med J 2003; 79: 463–6. 2. Bjornstad CCL, Gjersten E, Thorup F, et al. Temporary cardiac pacemaker treatment in five Norwegian regional hospitals. Scand Cardiovasc J 2012; 46: 137–43. 3. Gjesdal K, Johansen JB and Gadler F. Temporary emergency pacing: an orphan in district hospitals. Scand Cardiovasc J 2012; 46: 128–30. 4. Birkhahn RH, Gaeta TJ, Tloczkowski J, et al. Emergency Medicine-Trained Physicians are proficient in the insertion of Transvenous Pacemakers. Ann Emerg Med 2004; 43: 469–74. 5. Brignole M, Auricchio A, Baron-Esquivas G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2013; 34:2281–329. 6. Graham AS, Ozment C, Tegtmeyer K, et al. Central Venous Catheterization. N Engl J Med 2007; 356:e21. 7. Aguilera P, Durham BA and Riley DA. Emergency Transvenous Cardiac Pacing Placement Using Ultrasound Guidance. Ann Emerg Med 2000; 36: 224–7. 8. Pinneri F, Frea S, Najd K, et al. Echocardiography-guided versus fluoroscopy-guided temporary pacing in the emergency setting: an observational study. J Cardiovasc Med 2012; 14: 242–6. 9. Leung J, Duffy M and Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med 2006; 48: 540–7. 10. Tsang TS, Enriquez-Serano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002; 77: 429-36. 11. Hodgkiss Harlow K, Back MR, Brumberg R, et al. Technical factors affecting the accuracy of bedside IVC filter placement using intravascular ultrasound. Vasc Endovasc Surg 2012; 46: 293–9. 12. Wen M, Stock K, Heemann U, et al. Agitated Saline BubbleEnhanced Transthoracic Echocardiography: A Novel Method to visualize the Position of Central Venous Catheter. Crit Care Med 2014; 42: e231–3. 13. Francis GS, Williams SV, Achord JL, et al. Clinical competence in insertion of a temporary transvenous ventricular pacemaker. A statement for physicians from the ACP/ ACC/AHA Task Force on Clinical Privileges in Cardiology. Circulation 1994; 89:1913–6. 14. Harrigan RA, Chan TC, Moonblatt S, et al. Temporary transvenous pacemaker placement in the emergency department. J Emerg Med 2007; 1:105–11.
Downloaded from acc.sagepub.com at HOWARD UNIV UNDERGRAD LIBRARY on February 23, 2015
