Author + information
- Received April 1, 2019
- Revision received October 28, 2019
- Accepted October 31, 2019
- Published online March 16, 2020.
- Ralph Cipriano, MD∗ (, )
- Ashwani Gupta, MBBS,
- Faiz Subzposh, MD,
- James A. McCaffrey, MD,
- Eduard Koman, MD,
- David Fridman, MD,
- Heath Saltzman, MD, FHRS and
- Steven P. Kutalek, MD, FHRS
- ↵∗Address for correspondence:
Dr. Ralph Cipriano, Drexel University College of Medicine, 245 North 15th Street, MS 470, Philadelphia, Pennsylvania 19102.
Objectives This study investigated the performance of Temporary Pacing via an Externalized Active-Fixation (TPEAF) lead.
Background The incidence of cardiac implantable electronic device infections is increasing, which necessitates the need for transvenous lead extraction (TLE). Pacemaker-dependent patients require temporary pacing during the guideline-recommended waiting period before reimplantation. Data regarding safety and efficacy of TPEAF leads are very limited.
Methods We evaluated patients implanted with TPEAF leads post-TLE at our center between April 2004 and December 2017.
Results TPEAF leads were placed in 158 patients. The mean age was 74 ± 11 years. The median duration of the temporary lead was 6 days (range 1 to 29). There were 4 procedural complications (2.5% incidence): 1 patient had cardiac arrest from hyperkalemia, 2 developed cardiac tamponade, and 1 had profuse bleeding from the entry point of the leads. There were 13 complications post-implantation (8.2% incidence): 8 lead dislodgments, 1 elevated pacing threshold, 2 vegetations on the temporary lead, 1 pneumothorax, and 1 loss of capture due to the generator “safety switch.” All dislodgements occurred within 24 h, except 1 on day 3. Sixteen patients died during the hospital stay: 10 due to septic shock, 2 due to hyperkalemic cardiac arrest, 3 due to ventricular tachycardia, and 1 due to a massive cerebrovascular accident.
Conclusions The use of TPEAF leads is safe and efficacious in pacemaker-dependent patients post-TLE. Dislodgement can occur within the first 24 h. The presence of persistent fever and positive blood cultures should raise concern for vegetation on the temporary lead.
- active-fixation lead
- lead extraction
- lead dislodgement
- pacemaker dependent
- safety switch
- temporary pacing
Dr. Kutalek is a consultant for Spectranetics Corp., St. Jude Medical, Boston Scientific, Medtronic, and Sorin. Dr. Saltzman has received speaking/training honoraria from Boston Scientific, Biosense Webster, Sorin, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 1, 2019.
- Revision received October 28, 2019.
- Accepted October 31, 2019.
- 2020 American College of Cardiology Foundation
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