title: Temporary Transvenous Cardiac Pacing in Patients With Acute Myocardial Infarction Predicts Increased Mortality.
abstract: BACKGROUND
  Temporary pacemakers (TP) are used in emergency situations for severe bradyarrhythmias secondary to acute myocardial infarction (AMI) and to non-AMI related cardiac disorders. TP have been studied previously in AMI patients treated with thrombolytic therapy; limited information is available on current outcomes in AMI patients treated with percutaneous coronary intervention.
  
  
  METHODS
  We reviewed the indications, complications, and mortality associated with TP insertion over a four year period (2003 - 2007) at a university hospital.
  
  
  RESULTS
  Seventy-three temporary pacemakers were inserted (47 men, 26 women) during this period. The mean age was 65.2 years. TP were used in 29 AMI patients (39.7 % of total) and 44 non-AMI patients (60.3% of total). The duration of TP use was 2.6 ± 0.4 days in the whole cohort, 2.46 % of all AMI patients (29/1180) admitted during this period required a TP. Six of these patients requiring a TP required a permanent pacemaker. Eight patients with AMI and a TP died (27.6%). In contrast 8.9 % of AMI patients not requiring a TP died (P < 0.01). There were no statistically significant differences between the AMI and non-AMI groups in the duration of temporary pacing (2.4 ± 0.6 days vs. 2.8 ± 0.4 days), in complications (27.6% vs. 29.5%), or in mortality (27.6% vs. 15.9%). The need for a permanent pacemaker (PPM) differed significantly between the AMI and non-AMI patients (20.7% vs. 54.5%; P < 0.05).
  
  
  CONCLUSIONS
  Our results indicate that AMI patients infrequently require a TP and that approximately 20% of these patients require a PPM. These results suggest that early revascularization of the conduction system with current interventional techniques has decreased the need for TP in AMI patients. However, this group requires more intensive monitoring as the mortality rate in this group of patients is significantly higher than the other AMI patients not requiring TP.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, USA.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Yaqub
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Perez-Verdia
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, USA.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Jenkins
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, USA.
authors.forename: Shermila
authors.initials: S
authors.lastname: Sehli
authors.affiliation: Department of Mathematics and Statistics, Texas Tech University, Lubbock Texas, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Paige
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Nugent
keywords: Acute myocardial infarction; Bradyarrhthymias; Mortality; Temporary pacemakers