What is the procedure for insertion of a temporary implantable cardioverter-defibrillator (ICD) or pacemaker?

Updated: Feb 13, 2017
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Answer

Temporary systems use an external pulse generator with leads placed either transcutaneously or transvenously. Transcutaneous leads are the easiest and most convenient to use for rapid application of temporary pacing, and they are the method of choice during emergency department (ED) resuscitation. Transcutaneous pacing may be uncomfortable, and patients may require mild sedation (eg, benzodiazepine). Transcutaneous pacing may also fail to reliably induce cardiac contraction. Often, transvenous pacing must be established to reliably stabilize cardiac rhythm. Once the central venous access is gained, transvenous leads provide the most reliable and comfortable pacing mechanism and are a good transition to permanent systems.

Under ideal circumstances, most temporary pacing catheters are inserted with fluoroscopic guidance in a catheterization laboratory. In more emergent situations, flexible, balloon-tipped catheters may be positioned using only electrocardiographic monitoring.

Many patients who undergo implantable cardioverter-defibrillator or pacemaker implantation are anticoagulated with warfarin. A strategy of implanting devices during uninterrupted warfarin therapy has a lower bleeding risk than a strategy of temporarily discontinuing warfarin and bridging with heparin. [43] We await similar data for newer anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban.


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