Thomas S Metkus1, Steven P Schulman2, Joseph E Marine2, Shaker M Eid3. 1. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tmetkus1@jhmi.edu. 2. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
BACKGROUND: The incidence of complications and the outcomes of temporary transvenous pacemaker (TTP) placement in the modern era are not well established. METHODS: To determine the current incidence of pericardial complications and the outcomes of patients undergoing TTP, we performed an analysis using the National Inpatient Sample (NIS), which is a US national database of hospital admissions. All patients who underwent TTP were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. A multivariate logistic regression model was constructed for a primary outcome of pericardial tamponade and another for a primary outcome of in-hospital mortality. RESULTS: A total of 360,223 patients underwent TTP placement in the United States between 2004 and 2014. In-hospital mortality was 14.1%, and 37.9% later underwent permanent pacemaker implantation. Potential procedural complications included pericardial tamponade in 0.6% of patients, pneumothorax in 0.9% of patients, and non-pericardial bleeding in 2.4% of patients. In adjusted models, female sex (OR, 1.33 [95% CI, 1.09-1.64]; P = .005), in-hospital cardiac arrest (OR, 3.52 [95% CI, 2.76-4.48]; P < .001), teaching hospital status (OR, 1.91 [95% CI, 1.53-2.40]; P < .001), and previous coronary artery bypass grafting (OR, 0.26 [95% CI, 0.14-0.49]; P < .001) were associated with tamponade. Following multivariate adjustment, pericardial tamponade complicating TTP insertion was associated with a fivefold increase in risk for in-hospital death (OR, 5.00 [95% CI, 2.51-9.96]; P < .001). CONCLUSIONS: TTP placement is generally safe with low pericardial complication rates. Clinicians should be mindful of infrequent but serious complications of TTP, and strategies to mitigate pericardial tamponade and other complications should be sought and implemented.
BACKGROUND: The incidence of complications and the outcomes of temporary transvenous pacemaker (TTP) placement in the modern era are not well established. METHODS: To determine the current incidence of pericardial complications and the outcomes of patients undergoing TTP, we performed an analysis using the National Inpatient Sample (NIS), which is a US national database of hospital admissions. All patients who underwent TTP were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. A multivariate logistic regression model was constructed for a primary outcome of pericardial tamponade and another for a primary outcome of in-hospital mortality. RESULTS: A total of 360,223 patients underwent TTP placement in the United States between 2004 and 2014. In-hospital mortality was 14.1%, and 37.9% later underwent permanent pacemaker implantation. Potential procedural complications included pericardial tamponade in 0.6% of patients, pneumothorax in 0.9% of patients, and non-pericardial bleeding in 2.4% of patients. In adjusted models, female sex (OR, 1.33 [95% CI, 1.09-1.64]; P = .005), in-hospital cardiac arrest (OR, 3.52 [95% CI, 2.76-4.48]; P < .001), teaching hospital status (OR, 1.91 [95% CI, 1.53-2.40]; P < .001), and previous coronary artery bypass grafting (OR, 0.26 [95% CI, 0.14-0.49]; P < .001) were associated with tamponade. Following multivariate adjustment, pericardial tamponade complicating TTP insertion was associated with a fivefold increase in risk for in-hospital death (OR, 5.00 [95% CI, 2.51-9.96]; P < .001). CONCLUSIONS: TTP placement is generally safe with low pericardial complication rates. Clinicians should be mindful of infrequent but serious complications of TTP, and strategies to mitigate pericardial tamponade and other complications should be sought and implemented.
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