title: Echocardiography-guided versus fluoroscopy-guided temporary pacing in the emergency setting:  an observational study.
abstract: BACKGROUND
  The insertion of a temporary pacemaker can be a lifesaving procedure in the emergency setting.
  
  
  OBJECTIVE
  This is an observational monocentric study comparing echocardiography-guided temporary pacemaker via the right internal jugular vein to standard fluoroscopy-guided temporary pacemaker via the femoral vein; the procedure was tested for noninferiority.
  
  
  METHODS
  Patients needing urgent pacing were consecutively enrolled. Primary efficacy endpoints were time to pacing and need for catheter replacement. Primary safety endpoint was a composite outcome of overall complications.
  
  
  RESULTS
  One hundred and six patients (77 ± 10 years) were enrolled: 53 underwent echocardiographic-guided and 53 fluoroscopy-guided temporary pacemaker. Baseline characteristics of the two groups of treatment were similar. Time to pacing was shorter in the echocardiography-guided than in the fluoroscopy-guided group (439 ± 179 vs. 716 ± 235 s; P<0.0001; power 100%). During the pacing (54 ± 35 h), there was a higher incidence of pacemaker malfunction in the fluoroscopy-guided group [15 vs. 3 patients; odds ratio (OR) 6.5, confidence interval (CI) 95% 1.9-29.7, P<0.001; power 5.7%] and there was a significantly lower incidence of complications in the echocardiography-guided temporary pacemaker group (6 vs. 22 patients; OR 0.18, CI 95% 0.06-0.49, P<0.001; echocardiography-guided temporary pacemaker events rate 0.1929 vs. fluoroscopy-guided temporary pacemaker events rate 1.398 per 100 person-hours paced, P<0.0001). In the standard group there was one death attributable to a temporary pacemaker complication (sepsis).
  
  
  CONCLUSIONS
  Echocardiography-guided temporary pacemaker is a well-tolerated procedure that could allow reliable insertion of a temporary pacemaker; therefore, it is a well-tolerated option in an emergency setting and in hospitals where fluoroscopy is not available.
authors.affiliation: Division of Cardiology, Internal Medicine Department, Ospedale Civico di Chivasso, Italy. pinnerif@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Pinneri
authors.forename: Simone
authors.initials: S
authors.lastname: Frea
authors.forename: Kamal
authors.initials: K
authors.lastname: Najd
authors.forename: Silvana
authors.initials: S
authors.lastname: Panella
authors.forename: Erica
authors.initials: E
authors.lastname: Franco
authors.forename: Valentina
authors.initials: V
authors.lastname: Conti
authors.forename: Giuditta
authors.initials: G
authors.lastname: Corgnati
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods; D004630:Emergencies; D004868:Equipment Failure; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005471:Fluoroscopy; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D015641:Radiography, Interventional / Q000379:methods*; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*