Temporary transvenous VDD pacing as a bridge to permanent pacemaker implantation in patients with sepsis and haemodynamically significant atrioventricular block.
OBJECTIVE
Permanent pacemaker (PM) implantation is temporarily contraindicated in patients (pts) with sepsis. In patients with symptomatic atrioventricular (AV) block and infection, prolonged VVI pacing is therefore usually ensured by a ventricular pacing lead (PL) connected to an external PM generator. In patients with normal sinus function and heart failure, the VVI mode can exacerbate haemodynamic dysfunction. A single AV PL can be attractive to achieve physiological pacing. This study was designed to assess the efficacy and safety of temporary VDD pacing as a bridge to permanent PM implantation in patients with complete AV block until control of infection.


RESULTS
This study included eight patients with complete AV block and sepsis with negative blood culture. Due to the presence of congestive heart failure, a single bipolar AV PL connected to an external VDD PM generator. At VDD implantation, P-wave amplitude was 1.9 ± 1.6 mV and R-wave was 11.3 ± 5.2 mV. The ventricular pacing threshold was 0.53 ± 0.1 V for a 0.5 ms pulse. Antibiotic therapy was instituted in all patients. A permanent VDD or DDD PM was implanted after 8 ± 2.5 days of temporary VDD pacing. At permanent PM implantation, the mean brain natriuretic peptide level had decreased and sepsis was controlled in all patients. No recurrence of sepsis was observed with a mean follow-up of 15.8 ± 5.3 months.


CONCLUSIONS
Temporary VDD pacing is a safe and effective method to achieve prolonged AV physiological pacing in patients with AV block until infection has been controlled.
Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015, Paris, France. antoine.lepillier@yahoo.com
Antoine
A
Lepillier
Akli
A
Otmani
Xavier
X
Waintraub
Jacky
J
Ollitrault
Jeanyves
J
Le Heuzey
Thomas
T
Lavergne
D000368:Aged; D054537:Atrioventricular Block / Q000150:complications* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006333:Heart Failure; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D018805:Sepsis / Q000150:complications*; D016896:Treatment Outcome