Surgical aspects of transvenous endocardial pacemaker

Abstract

Retrospective review of 202 surgical procedures for transvenous endocardial pacemaker implantation, generator change, or repositioning of the electrode in the past ten years are presented in this paper. The age of distribution for initial implantation of pacemakers are mostly in the sixth and seventh decades of life. The youngest age was 27 years, the oldest 92 years and the mean age was 72.0. The male/female ratio was 2-1. The major indication for implantation of permanent pacemakers was complete A-V block in 51 per cent, mobitz II A-V block in 17.3 per cent and sick sinus syndrome in 14.4 per cent. The surgical procedure for transvenous endocardial pacemaker implantation includes the insertion of temporary pacemakers, using local anesthesia and choosing the right cephalic vein. Under fluoroscopy, the endocardial electrode is passed to the right ventricle to obtain a threshold of about 0.7 milliamperes. Antibiotic lavage of the wound, pressure dressings, and postoperative antibiotics for three to four days are used. There were no operative mortalities, and the major electrode complications were electrode displacement in 15.5 per cent, high threshold in 12.5 per cent, and cardiac perforation in 0.8 per cent. The premature generator exhaustion rate was 8.4 per cent, and wound infection from skin erosion was 0.5 per cent. Transvenous endocardial pacemaker is a relatively safe procedure with minimal operative complication. It prolongs life and greatly enhances its quality. Current available generators, analyzers, electric hazards, and relationships to radiation therapy are discussed.