Background: Heart rhythm emergencies require specialist expertise from cardiologists and cardiologists who specialise in heart rhythm disorders. Currently access to such services across Liverpool and the wider UK is insufficient. This has led to a number of high-profile adverse events where in some cases have resulted in avoidable morbidity and mortality. In particular, patients presenting with bradycardia emergencies may find themselves in a centre where there is no access to acute temporary pacing. Access to permanent pacing requires a long in hospital wait or a transfer to a second centre. Data suggests that temporary pacing systems placed by non-cardiologists have up to a 60% complication rate. Even when placed by a cardiologist, there is a complication rate of up to 20% (McCann 2006). Published data show temporary pacing systems carry a 10% risk of septicaemia and a 4.5% risk of pneumothorax or cardiac perforation (Betts 2003). In almost a quarter of cases, the implantation of the permanent system is delayed by a temporary pacing wire complication. Long wait for inpatient devices and the risks to patients have prompted the British Heart Rhythm Society (BHRS) in 2016 to produce a document that states early access to permanent pacing and temporary pacing on 24/7 basis.
Methods/Purpose: We analysed the retrospective data April 2018 to March 2019 in Liverpool region. Our key objectives were to assess the following:
- Time frame from point of diagnosis to actual treatment
- Complications and factors that prolonged the hospital stay
- Non clinical factors that potentially delayed the treatment (logistics – transfers, bed availability, referral delays)
This will help us understand the logistic barriers to efficient and streamlined care.
Results: A total of 227 patients were admitted for non-elective pacemaker implantation. 82 patients with acute brady arrhythmias were transferred from a local district hospital without any pacing service provision. 80 out of 82 patients received a permanent pacing device within 36 hrs of admission at our tertiary centre. Remaining 2 received pacemaker within 72 hours. Complications, there were 2 lead displacements and 2 pneumothoraxes (1 required chest drain). Length of stay post procedure 0-22 days, mean ± SD 2.02 days. 43 patients were discharged or treated and returned within 24 hours. In this process we interpreted that the process of pacemaker implantation in acute brady arrhythmias can expedited by transferring the patient straight to the tertiary centre for urgent pacemaker implantation. This would the prevent the delay in getting the treatment to the patient and also avoid unnecessary complications whilst waiting for the transfer, prolonged stay in hospital and reduced procedure related complications.
Conclusion: In providing a primary pacing service 24/7, we realised the following are essential in setting up the service:
| Reduced wait for patient’s permanent implantation system | Timely elective list attendance Timely non elective transfer Weekend pacing lists |
| Reduce patients for permanent pacing transferred with temporary systems | Procedure performed in a stabilised tertiary care |
| Reduce number of transfers before receiving treatment | Emergency services to identify more direct transfer to Liverpool Heart |
