title: Utility and safety of temporary pacing using active fixation leads and externalized re-usable permanent pacemakers after lead extraction.
abstract: OBJECTIVE
  After extraction of an infected cardiac implantable electronic device (CIED) in a pacemaker-dependent patient, a temporary pacemaker wire may be required for long periods during antibiotic treatment. Loss of capture and under sensing are commonly observed over time with temporary pacemaker wires, and patient mobility is restricted. The use of an externalized permanent active-fixation pacemaker lead connected to a permanent pacemaker generator for temporary pacing may be beneficial because of improved lead stability, and greater patient mobility and comfort. The aim of this study was to investigate the efficacy and safety of a temporary permanent pacemaker (TPPM) system in patients undergoing transvenous lead extraction due to CIED infection.
  
  
  RESULTS
  Of 47 patients who underwent lead extraction due to CIED infection over a 2-year period at our centre, 23 were pacemaker dependent and underwent TPPM implantation. A permanent pacemaker lead was implanted in the right ventricle via the internal jugular vein and connected to a TPPM generator, which was secured externally at the base of the neck. The TPPM was used for a mean of 19.4 ± 11.9 days (median 18 days, range 3-45 days), without loss of capture or sensing failure in any patient. Twelve of 23 patients were discharged home or to a nursing facility with the TPPM until completion of antibiotic treatment and re-implantation of a new permanent pacemaker.
  
  
  CONCLUSIONS
  External TPPMs are safe and effective in patients requiring long-term pacing after infected CIED removal.
authors.affiliation: San Diego Health System, Sulpizio Cardiovascular Center, University of California, 9444 Medical Center Dr. MC 7411, La Jolla, CA 92037, USA. hkawata@ucsd.edu
authors.forename: Hiro
authors.initials: H
authors.lastname: Kawata
authors.forename: Victor
authors.initials: V
authors.lastname: Pretorius
authors.forename: Huy
authors.initials: H
authors.lastname: Phan
authors.forename: Siva
authors.initials: S
authors.lastname: Mulpuru
authors.forename: Varuna
authors.initials: V
authors.lastname: Gadiyaram
authors.forename: Jigar
authors.initials: J
authors.lastname: Patel
authors.forename: Dawna
authors.initials: D
authors.lastname: Steltzner
authors.forename: David
authors.initials: D
authors.lastname: Krummen
authors.forename: Gregory
authors.initials: G
authors.lastname: Feld
authors.forename: Ulrika
authors.initials: U
authors.lastname: Birgersdotter-Green
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D020878:Device Removal / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004869:Equipment Safety; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors
keywords: Cardiac implantable electronic device infection; Lead extraction; Temporary pacemaker; Temporary permanent pacemaker