Hybrid Long-term Temporary Pacing
Prolonged temporary pacing is associated with frequent complications. We describe a patient with aortic endocarditis and acquired tri-fascicular block in whom back-up pacing was indicated. Using a Seldinger technique via a subclavian approach, a permanent active-fixation lead was positioned in the right ventricle. The lead was tunnelled subcutaneously for 6cm, and the proximal end was connected to a standard single chamber pulse generator. The procedure was well tolerated and over a period of four months there were no complications or infection. The PR interval subsequently reduced in duration to 200 ms and as no episodes of AV block had occurred, the lead was easily removed with retraction of the helix and gentle traction.

Temporary pacemakers are associated with high complication rates and if pacing is required for more than 24 hours, the need for repeat intervention to reposition the lead, or re-site the venous access is relatively commonplace. We describe a case where an alternative approach was taken to anticipated prolonged temporary pacing.