Incidence and predictors of temporary pacemaker implantation-induced cardiac perforation.

BACKGROUND

Cardiac perforation (CP) and cardiac tamponade (CT) are rare but dreaded complications of transvenous temporary pacing (TTP), with variable reported incidences and impacts on morbidity and mortality. The role of serial echocardiographic imaging in accurately detecting these complications has not been comprehensively investigated.

OBJECTIVES

This study aimed to determine the incidence of CP and CT after TTP using serial echocardiographic imaging, assess the timeline of CP and CT development, and identify predictors of CP and CT.

METHODS

A single-center, prospective, observational study was conducted at a tertiary care hospital in North India from January 2015 through December 2019. A total of 641 consecutive patients undergoing TTP were studied. Serial echocardiographic evaluations were performed at multiple predefined time points: before and after TTP, after permanent heart rhythm device implantation, before TTP electrode removal, after TTP electrode removal, and before discharge. Patients with preexisting pericardial effusion or those requiring cardiopulmonary resuscitation were excluded. Univariate and multivariate Cox regression analyses were performed to determine the predictors of CP and CT.

RESULTS

CP was observed in 59 (9.2%) patients. Small, moderate, and large effusions were observed in 33 (5.1%), 18 (2.8%), and 8 (1.2%) patients, respectively. Serial echocardiographic imaging detected new effusions in 3.7%, 1.1%, and 2.3% of patients after TTP electrode implantation, before temporary electrode removal, and after temporary electrode removal, respectively. Renal dysfunction and longer TTP duration were found to be significant predictors of CP.

CONCLUSION

The use of serial echocardiographic imaging as a routine monitoring tool during TTP procedures enhances the early detection of CP and CT.