From the Guidelines
Pacemakers are categorized into permanent and temporary (demand) types, with the primary distinction being the duration of use and the nature of the patient's cardiac condition, as outlined in the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1.
Key Differences
- Permanent pacemakers are implanted for long-term management of persistent conduction disorders, such as complete heart block, sick sinus syndrome, or symptomatic bradycardia, and are recommended for patients with acquired second-degree Mobitz type II atrioventricular block, high-grade atrioventricular block, or third-degree atrioventricular block not caused by reversible or physiologic causes, regardless of symptoms 1.
- Temporary or demand pacemakers are used for short-term management of reversible conditions, such as bradycardia following cardiac surgery, drug overdose, or acute myocardial infarction, and can be transcutaneous or transvenous.
Clinical Considerations
- The choice between permanent and temporary pacemakers depends on whether the patient's condition is expected to improve or requires lifelong management, with consideration of the patient's goals of care and preferences, as emphasized in the guideline 1.
- Techniques that provide more physiologic ventricular activation, such as cardiac resynchronization therapy or His bundle pacing, are preferred to right ventricular pacing in patients with a left ventricular ejection fraction between 36% to 50% and atrioventricular block, who are expected to require ventricular pacing >40% of the time 1.
- Shared decision-making and patient-centered care are essential in determining the type of pacemaker to be used, with consideration of the patient's decision-making capacity and legally defined surrogate, as outlined in the guideline 1.
From the Research
Differences between Permanent and Temporary Pacemakers
- A permanent pacemaker is an implantable device that maintains the patient's heart rate by electrically stimulating the heart muscle when the natural regulating mechanisms fail 2.
- Temporary pacemakers, also known as demand pacemakers, are used in patients with life-threatening bradycardia and serve as a bridge to implantation of a permanent pacemaker (PPM) 3.
- Temporary cardiac pacing with passive fixation leads has been related to a higher incidence of infection and venous thrombosis, delayed recovery, and increased length of stay, whereas temporary permanent pacemakers (TPPMs) with active fixation mechanisms have a very low risk of lead dislodgement and allow patients to ambulate 3.
Key Characteristics of Temporary and Permanent Pacemakers
- Temporary pacemakers are typically used for a shorter duration, ranging from a few days to several weeks or months, whereas permanent pacemakers are designed for long-term use 3, 4.
- Permanent pacemakers are implanted in patients with various conditions, including sinus node dysfunction, acquired atrioventricular block, and neurally mediated syndromes, and are most often utilized in older adults 4, 5.
- Temporary permanent pacemakers (TPPMs) have been shown to have overall favorable outcomes, with low complication rates, including device-related infections and loss of capture 3.
Patient Care and Support
- Patients with permanent cardiac pacemakers require highly skilled monitoring and a holistic approach to their care, including regular follow-up and support 5, 6.
- Nurses should be knowledgeable about the indications for permanent cardiac pacemakers, including the classification system established by the Joint American College of Cardiology/American Heart Association Task Force 5.
- Patients with temporary or permanent pacemakers should receive information, support, and monitoring to ensure optimal outcomes and prevent complications 6.