Outcomes of 4838 patients requiring temporary transvenous cardiac pacing: A statewide cohort study

Background: Temporary-transvenous-cardiac-pacing (TTCP) is a potentially lifesaving procedure, however trends in its utilization and outcomes in unselected contemporary populations are all unknown. Methods: Consecutive patients requiring TTCP between July-1, 2000 and December-31, 2013 were identified from a statewide registry of admitted patients. In addition, all patients who underwent other cardiac procedures including permanent-pacemaker (PPM) implantation, automated-implantable-cardiac-defibrillator (AICD) implantation, percutaneous-coronary-intervention (PCI), or coronary-artery-bypass-graft (CABG) surgery were identified for comparative outcome analyses. Survival was tracked from a statewide death registry. Results: A total of 4838 patients (mean age [+/- standard deviation] 74.7 +/- 12.7 years; 58.0% males) requiring TTCP were identified. The incidence for TTCP was 5.86 +/- 1.06 cases per-100,000-persons-per-annum, declining by 46% between 2003 and 2013. During 4.2 +/- 3.7 years of follow-up, 2594 (53.6%) patients died, of whom 569 (11.8%) died during the index admission. Weekend admission was associated with increased mortality compared to week-days (hazard ratio: 1.15, 95% confidence interval [CI] 1.06-1.26, p=0.002) and independently predicted all-cause death. After adjusting for age, gender, comorbidities, and referral source for admission, patients requiring TTCP had worse survival than those undergoing PPM (n = 17,988) or AICD (n = 5264) implantation, PCI (n= 46,859), or CABG surgery (n = 50,992) (adjusted hazard ratio [aHR]: 2.14, 95% CI 1.94-2.37; aHR: 1.61, 95% CI 1.41-1.83; aHR: 1.76, 95% CI 1.61-1.93; aHR: 2.09, 95% CI 1.98-2.21 respectively, all p < 0.001). Conclusion: TTCP utilization is decreasing and is associated with substantial in-hospital and long-term mortality with weekend-weekday variation in outcome. Further studies are needed to develop strategies to better understand the determinants of adverse outcomes of these patients, as well as appropriate strategies for outcome improvement. (c) 2018 Elsevier B.V. All rights reserved.