Temporary transvenous pacing performed in the intensive care unit or in
the catheterization laboratory: a retrospective study
Abstract
Background: Temporary transvenous pacing (TTP) is a common
procedure, predominantly performed in the catheterization laboratory
(cath lab) because of presumed lower complication rate. This study aims
to evaluate the efficacy and safety of TTP placement in the ICU compared
to TTP placement in the cath lab. Methods and results: This
retrospective, real-life study included all patients requiring TTP in a
tertiary care ICU between 2019 and 2022. Patients’ characteristics,
TTP-related data, outcomes, and complications were compared between
groups (ICU vs. cath lab). Data from 193 patients receiving TTP were
analyzed; 68.4% received TTP in the ICU and 31.6% in the cath lab. The
main indication was atrioventricular block in 154 patients (79.8%). The
operator was less frequently an interventional cardiologist in the ICU
(12.1%) compared to the cath lab (100%, p<0.001). TTP in the
ICU was more frequently performed using a jugular access (72.0 vs.
1.6%), a right-sided laterality (88.7 vs. 43.6%), and a balloon-tipped
catheter (100% vs. 0%, p<0.001 for all comparisons). Success
was 100% in both groups. The overall complication rate was 16.6%, with
no significant difference between both groups (14.4% ICU vs. 21.3%
cath lab, p=0.13), but a tendency toward higher complications in the
cath lab group (especially tamponade, lead displacement, and CIED
infection). Conclusion: In a daily clinical scenario, TTP
placement appears as safe in the ICU than in the cath lab, regardless of
the operator’s level of expertise when performed in accordance with best
practices. Nevertheless, TTP complications remain high and alternatives
should be used whenever possible.