Bradycardia: balloon-flotation catheters were easier to position optimally

Clinical bottom line (level 1b)

  1. Patients with bradyarrhythmias who were given balloon-flotation (rather than semirigid) catheter pacing, were more likely to have a satisfactory catheter position. (NNT = 2 at unknown)
  2. The balloon-flotation catheter procedure duration was shorter than the semirigid catheter procedure (264 seconds versus 540 seconds).
Ferguson et al: The Lancet 1997; 349: 1883-1883
Expires August 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: general hospital, UK

40 patients (aged mean 72 years, ?% male) undergoing temporary ventricular-demand pacing for atrioventricular block with or without myocardial infarction, sinus arrest or ventricular tachycardia.
Note:
  • Crossover was allowed if pacing had not been established with the initial catheter after 5 minutes fluoroscopy.
  • Assessment of successful positioning was by an in dependant observer.


    • Control Group: (n = 20, 20 analysed): semirigid electrode catheter
    Experimental Group: (n = 20, 20 analysed): balloon-flotation electrode catheter

    100% followed for ?
    Outcome notes:
    • satisfactory catheter position : tip in the right ventricular apex pointing horizontally or inferiorly with an adequate atrial loop
    • suboptimum catheter position : tip at the apex but pointing superiorly or with an inadequate atrial loop or both
    • unacceptable catheter position : tip placed outside the right ventricular apex

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    satisfactory catheter position unknown 2
    (10.0%)    		 14
    (70.0%)    		 -600%
    (-2589% to -82.0%)    		 -60.0%
    (-84.0% to -36.0%)    		 2
    (1.00 to 3.00)
    suboptimum catheter position unknown 12
    (60.0%)    		 5
    (25.0%)    		 58.0%
    (4.00% to 82.0%)    		 35.0%
    (6.34% to 63.7%)    		 -3
    (-16.0 to -2.00)
    unacceptable catheter position unknown 7
    (35.0%)    		 0
    (0.00%)    		 100%
    (% to %)    		 35.0%
    (14.1% to 55.9%)    		 3
    (2.00 to 7.00)

  • The median procedure duration for the semirigid catheter was 540 seconds and for the balloon-flotation catheter was 264 seconds.
  • The median fluoroscopy time with the semirigid catheter was 189 seconds and with the balloon-flotation catheter was 87 seconds.

    • Comments

    1. Although no direct comment is made on the experience of the cardiologists, the duration of fluoroscopy suggests a fair degree of skill.
    2. Displacement (requiring repositioning) occurred in 3 patients in the semirigid group and 1 in the balloon-flotation group. Two deaths occurred in the semirigid group (1 during repositioning, and ventricular perforation in the other).
    3. Crossover was only required in 1 of 20 patients allocated to the semirigid catheter group and 2 of 20 in the balloon-flotation catheter group.

    Citation

    1. Ferguson JD, Banning AP, Bashir Y: Randomised trial of temporary cardiac pacing with semirigid and balloon-flotation electrode catheters. The Lancet 1997; 349: 1883-1883
    Contributor: Clare Wotton and Bob Phillips, August 1999
    Reviewer: Etsuo Tsuchikane

    Clinical Question.
    Patient bradyarrhythmias
    Intervention or Exposure semirigid catheter pacing
    Comparison balloon-flotation catheter pacing
    Outcome catheter position and duration of procedure