Background Balloon Tipped Temporary Pacemakers (BTTP) are the most used temporary pacemakers; however, they are associated with a risk of dislodgement and thromboembolism. Recently, Temporary Permanent Pacemakers (TPPM) have become increasingly used. Evidence of better outcomes with TPPM compared to BTTP is still scarce. Materials and methods Retrospective, chart review study evaluating all patients who underwent temporary pacemaker placement between 2014 and 2022 (N=126) in the cardiac catheterization laboratory (CCL) at a level 1 trauma center. Primary outcome of this study is to evaluate the safety profile of TPPM vs BTTP. Secondary objectives include patient ambulation and healthcare utilization in patients with temporary pacemakers. Results Both groups had similar baseline characteristics distribution including gender, race and age at temporary pacemaker insertion (p>0.05). Subclavian vein was the most common site of access for the TPPM cohort (89.0%) vs the femoral vein in the BTTP group (65.1%). Ambulation was only possible in the TPPM group (55.6%, p<0.001). Lead dislodgement, venous thromboembolism, local hematoma, and access site infections were less frequently encountered in the TPPM group (OR = 0.23 [95% CI (0.10-0.67), P<0.001]). Within the subgroup of patients with TPPM, 36.6% of the patients were monitored outside the ICU setting. There was no significant difference in the pacemaker related adverse events among patients with TPPM based on their in-hospital setting. Conclusion TPPM are associated with more favorable safety profile compared to BTTP. They are also associated with earlier patient ambulation and reduced healthcare utilization.

This editorial reviews the data to guide the discussion on whether or not to replace implantable cardioverter-defibrillator generator when the left ventricular ejection fraction has improved.

Objective: Examine the trajectory of left ventricular ejection fraction (EF) among patients eligible for implantable cardioverter-defibrillator (ICD) therapy Background: Ejection fraction is the cornerstone criterion for ICD therapy, but the risk of sudden cardiac death (SCD) remains after an improvement in EF. Methods: We examined the trajectory of EF among 1178 participants of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) who had 3 or more assessments of EF, at least 90 days apart. A follow-up EF >35% or >10% absolute increase in EF from baseline were examined as the criteria for EF improvement. Results: At first follow-up, 381 (32%) patients had an improvement of EF to >35%. However, EF had returned back to 35% in 109 (27%) of these patients at second follow-up. Similarly, 446 (38%) patients experienced a >10% improvement in EF at first follow-up, but 109 (24%) of these had a subsequent >10% decrease in EF at the second follow-up. Of the 32 patients with normalized EF (≥55%) at first follow-up, 18 (56%) had a subsequent >10% decrease in EF. The fluctuation in EF was present in both ischemic and non-ischemic cardiomyopathy but a higher proportion of patients with non-ischemic cardiomyopathy had an improvement in EF to >35% at first follow-up compared to those with ischemic cardiomyopathy (38% vs. 27%, p=<0.0001). Conclusion: There is substantial fluctuation of EF among patients who are eligible for ICD therapy. These data may help explain the continued risk of SCD after improvement in EF.