title: Risk of early mortality after placement of a temporary-permanent pacemaker.
abstract: Temporary-permanent pacemakers [TPPM] are externally placed permanent generators attached to active fixation transvenous leads. TPPM can be used as an alternative to standard temporary pacing leads when placement of a permanent pacemaker is contraindicated. We sought to determine the incidence and risk factors for early (within 6months) mortality after placement of a TPPM.
  
  
  
  Electronic medical records were used to extract baseline characteristics for 152 patients from Wake Forest Baptist Medical Center who had a TPPM placed between the years 2007 and 2012. Multivariable adjusted Cox proportional hazard models were used to estimate hazard ratios [HR] and 95% confidence intervals [C]) for baseline characteristics [age, sex, race, hypertension, diabetes, heart failure, coronary artery disease, smoking, dyslipidemia, chronic kidney disease [CKD], and indication for pacemaker] on early mortality.
  
  
  
  Of the 152 patients [mean age 68.9years; 57.2% female; 86.8% white], 45 [29.6%] died within the first 6months after TPPM placement. No deaths occurred as a direct result of TPPM placement, and only 1 patient experienced documented non-fatal complications. Maximum time to PPM from the date of insertion of TPPM was 336days. Using a backward multivariable adjusted hazard regression model, independent risk factors for early mortality were pre-existing CKD [HR (95% CI): 2.240 (1.002-5.010) for eGFR 30-59 and 7.645 (3.594-16.263) for eGFR <30 compared to eGFR >60] and history of smoking [HR (95% CI): 2.015 (1.099-3.696)]. Surprisingly, dyslipidemia was protective of early mortality [HR (95%CI): 0.470 (0.240-0.924)].
  
  
  
  TPPM placement is a safe procedure with rare direct complications. CKD and smoking are predictive of increased risk for early mortality in patients undergoing TPPM placement.
authors.affiliation: Department of Internal Medicine- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC. Electronic address: fdawood@wakehealth.edu.
authors.forename: Farah Z
authors.initials: FZ
authors.lastname: Dawood
authors.affiliation: Department of Internal Medicine- General Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Andrew
authors.initials: A
authors.lastname: Boerkircher
authors.affiliation: Department of Internal Medicine- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Bryon
authors.initials: B
authors.lastname: Rubery
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Don
authors.initials: D
authors.lastname: Hire
authors.affiliation: Department of Internal Medicine- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D017677:Age Distribution; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000401:mortality* / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D019919:Prosthesis Implantation / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Heart pacing; Risk of mortality; Temporary pacemaker