Prolonged temporary cardiac pacing using an external permanent pacing system.

The number of pacemakers and implantable cardioverter defibrillators implanted each year continues to grow in Spain, due largely to the increased life expectancy of the population in the case of pacemakers and the indications for primary prevention in the case of implantable cardioverter defibrillators. Although the incidence of infections associated with implantable cardiac devices is not high, this complication is responsible for increased morbidity and mortality among affected patients. The strategy for achieving the best outcomes is complete removal of the system (electrodes and generator), along with prolonged antibiotic therapy. In addition to the general problems faced in pacinga defibrillation system with cardiac resynchronization was considered. While awaiting the procedure, the patient presented with an abscess in the region of the generator pocket. The system was completely removed and intravenous antibiotic therapy started to treat the late infectious process prior to implantation of the new system. In view of the complete dependence on pacing, it was decided, before removal, to implant a pacing system that would allow safe, easy, and prolonged physiologic pacing. Thus, with access via the left internal jugular vein and using a short sleeved introducer (Fig. 1A), a conventional permanent active fixation pacing electrode was advanced under radiologic guidance and in sterile conditions. The electrode was placed in the septal region of the right ventricle, with an optimum pacing threshold (Fig. 1B). The electrode was connected to a permanent sterilized pacemaker generator that had been removed from another patient without signs of infection. The generator was programmed in VVI/ R mode at 70 bpm to 120 bpm to allow a more physiologic pacing. The introducer was attached to the skin, the sleeve was attached to the electrode, and the generator was fixed with covering adhesive e , t y d y r t e y