Background: Cardiac perforation (CP) and cardiac tamponade (CT) are rare but dreaded complications of transvenous temporary cardiac pacing (TTP), with variable reported incidences and impacts on morbidity and mortality. The role of serial echocardiography in accurately detecting these complications has not been comprehensively investigated.
Objective: This study aimed to determine incidence of CP and CT following TTP using serial echocardiographic imaging, assess the timeline of CP and CT development, and identify predictors.
Methods: A single-centre, prospective, observational study was conducted at a tertiary care hospital in North India from January 2015 to December 2019. A total of 641 consecutive patients undergoing TTP were studied. Serial echocardiographic evaluations were performed at multiple predefined time points: before and after TTP, after permanent heart rhythm device (PHRD) implantation, before TTP removal, after TTP electrode removal, and before discharge. Patients with pre-existing pericardial effusion (PE) or those requiring cardiopulmonary resuscitation were excluded. Univariate and multivariate Cox regression analyses were done to determine the predictors of CP and CT.
Results: The incidence of CP was 9.2%. 5.1%, 2.8%, and 1.2% small, moderate, and large effusions were observed, respectively. Serial echocardiography detected new effusions in 3.7%, 1.1%, and 2.3% patients after TTP electrode implantation, before temporary electrode removal, and after temporary electrode removal, respectively. Renal dysfunction and longer TTP duration were found to be significant predictors of CP.
Conclusion: The use of serial echocardiography as a routine monitoring tool during TTP procedures is useful to enhance the early detection of CP and CT.
Keywords: cardiac perforation; cardiac tamponade; pericardial effusion; permanent heart rhythm device; serial echocardiographic screening; temporary transvenous pacemaker.
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