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Prolonged temporary cardiac pacing using subcutaneous tunnelled active-fixation permanent pacing leads
  1. N Lever,
  2. J D Ferguson,
  3. Y Bashir,
  4. K M Channon
  1. Departments of Cardiology and Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to:
    r Keith M Channon, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, OX3 9DU, UK;

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Temporary transvenous cardiac pacing is occasionally required for prolonged periods, particularly in patients with severe infection and bradyarrhythmias who may need several weeks of antibiotic treatment before a permanent pacemaker can be safely implanted. Prolonged temporary transvenous pacing is frequently associated with complications such as local or systemic infection, lead displacement, and right ventricular perforation,1,2 that necessitate sequential lead replacement or repositioning, subjecting patients to the risk, inconvenience, and additional cost of multiple invasive procedures. Furthermore, traditional external pulse generators significantly limit patients’ mobility and nursing care. We sought to overcome these problems by evaluating an alternative method for prolonged temporary pacing which (1) involves a single procedure, (2) provides reliable pacing for several weeks with a low risk of complications, and (3) allows patients to ambulate freely during this period.


A bipolar active-fixation permanent pacing lead (Medtronic 5068, 58 cm) was introduced via the internal jugular or subclavian vein using a peel-away introducer sheath, and positioned in the right ventricle under fluoroscopic guidance. Pacing parameters were checked with the active-fixation screw deployed. The lead was tunnelled subcutaneously to an exit point approximately 10 cm from the point of vascular access and secured to the skin using the suture sleeve (fig 1). Ventricular …

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