Temporary Pacing for Bradycardia

Use emergency temporary pacing when bradycardia produces hemodynamic instability or symptomatic deterioration and requires immediate rate support. Emergency indications include unstable bradyarrhythmias from degenerative conduction disease and acute coronary syndrome complicated by bradycardia. ScienceDirect+1ScienceDirectTransvenous Pacemaker Placement: A Review for Emergency ...PubMedTransesophageal echocardiography (TEE)-guided transvenous pacing (TVP) in emergency department - PMC

Treat pacing as a bridge when a reversible cause is being corrected or when definitive rhythm support is being arranged. External pacing is particularly useful in transient settings such as digoxin toxicity and atrioventricular block with inferior-wall myocardial infarction, but it should not be the sole strategy when prolonged temporary pacing is anticipated. PubMedPubMedUsing transcutaneous cardiac pacing to best advantage - PMC - NIH

Do not pace solely because the heart rate is low in a hemodynamically stable patient with rare or tolerable symptoms. Temporary pacing is also generally avoided in hypothermia and may be futile in prolonged bradyasystolic arrest, especially after delayed resuscitation exceeding 20 minutes. PubMed+1PubMedOverdrive Pacing - StatPearls - NCBI BookshelfPubMedUsing transcutaneous cardiac pacing to best advantage - PMC - NIH

Transcutaneous pacing is the fastest pacing method for many bradyarrhythmias and selected conduction disturbances. It is appropriate when transvenous pacing is not immediately available, when a transient cause is likely, or while a transvenous lead or permanent pacemaker is being arranged. PubMed+1PubMedTranscutaneous Pacing - StatPearls - NCBI Bookshelf - NIHPubMedUsing transcutaneous cardiac pacing to best advantage - PMC - NIH

Do not interpret pacing spikes alone as success. Confirm electrical capture on the ECG and mechanical capture by pulse palpation and hemodynamic response; a procedural checklist specifically requires pulse confirmation by a nonsterile assistant after electrical capture is seen. PubMedPubMedDevelopment of a Rigorously Designed Procedural Checklist for Assessment of Emergency Medicine Resident Performance of Temporary Transvenous Cardiac Pacing - PMC

Anticipate discomfort, possible failure of electrical or mechanical capture, monitoring interference, skin injury, and arrhythmia induction. Keep medications and a transvenous pacing system immediately available when external pacing may fail or when ongoing pacing is likely. PubMedPubMedTranscutaneous Pacing - StatPearls - NCBI Bookshelf - NIH

Temporary transvenous pacing is indicated for hemodynamically unstable symptomatic bradycardia when temporary pacing must be reliable or sustained. It is performed by advancing a catheter-based electrode to the right side of the heart through central venous access and connecting it to an external pulse generator. ScienceDirect+2ScienceDirectTransvenous Pacemaker Placement: A Review for Emergency ...PubMedOverdrive Pacing - StatPearls - NCBI BookshelfPubMedTransesophageal echocardiography (TEE)-guided transvenous pacing (TVP) in emergency department - PMC

Prepare the procedure with a 6 Fr percutaneous venous introducer sheath, transvenous pacing catheter, external generator, 12-lead-capable ECG, continuous cardiac monitoring, pulse oximetry, and noninvasive or invasive blood-pressure monitoring. Ultrasound guidance for central venous access is strongly recommended, and sterile technique is required. PubMedPubMedOverdrive Pacing - StatPearls - NCBI Bookshelf

After placement, identify the capture threshold by reducing output until capture is lost, then set output above the capture threshold; secure the lead and generator, obtain chest radiography to confirm lead position, and repeatedly assess for loss of capture. PubMed+1PubMedDevelopment of a Rigorously Designed Procedural Checklist for Assessment of Emergency Medicine Resident Performance of Temporary Transvenous Cardiac Pacing - PMCPubMedOverdrive Pacing - StatPearls - NCBI Bookshelf

In acute myocardial infarction, temporary pacing is used for clinically significant bradyarrhythmia and may be considered prophylactically when higher-degree AV block, severe sinus node dysfunction, or asystole is anticipated. Inferior MI, older age, worse Killip class, female sex, smoking, hypertension, and diabetes have been reported as predictors of AV block. Wolters KluwerWolters KluwerStudy of Bradyarrhythmias in Acute Myocardial... : Egyptian Journal of Critical Care Medicine

For suspected digoxin intoxication with advanced bradyarrhythmia, prioritize digoxin-specific Fab when indicated; a reported case of advanced toxicity had no ventricular-rate response to 3.0 mg IV atropine before temporary pervenous pacing was used. NEJMNEJMReversal of Advanced Digoxin Intoxication with Fab Fragments of ... Temporary pacing remains a bridge when clinically needed, not a substitute for toxin-directed therapy. PubMedPubMedUsing transcutaneous cardiac pacing to best advantage - PMC - NIH

For propranolol overdose with hypotension or depressed myocardial function, administer IV glucagon 50-150 mcg/kg followed by a 1-5 mg/hour infusion for chronotropic support; atropine or isoproterenol may treat bradycardia, and serious bradycardia may require temporary cardiac pacing. accessdata fdaaccessdata fda[PDF] Inderal - accessdata.fda.gov

For sotalol-associated bradycardia, cardiac asystole, or high-grade AV block, labeled rescue measures include atropine or another anticholinergic drug, a beta-adrenergic agonist, and transvenous pacing; second- and third-degree heart block may require transvenous pacing. accessdata fda+1accessdata fda[PDF] 3929060 This label may not be the latest approved by FDA. For ...accessdata fda[PDF] 205108Orig1s000 | FDA Bradycardia itself increases torsade de pointes risk in patients receiving sotalol. accessdata fdaaccessdata fda[PDF] 3929060 This label may not be the latest approved by FDA. For ...

Continue continuous ECG, pulse, blood-pressure, and oxygen-saturation monitoring while temporary pacing is active. For transvenous systems, reassess electrical and mechanical capture frequently because lead displacement or output failure can convert apparent pacing into ineffective support. PubMed+1PubMedOverdrive Pacing - StatPearls - NCBI BookshelfPubMedDevelopment of a Rigorously Designed Procedural Checklist for Assessment of Emergency Medicine Resident Performance of Temporary Transvenous Cardiac Pacing - PMC

Transition from temporary to permanent pacing only after evaluating whether the bradyarrhythmia is persistent and whether the patient can safely receive a transvenous permanent device. Active infection, especially bacteremia, is a reason not to implant a transvenous permanent pacemaker; unfavorable vascular or cardiac anatomy may warrant epicardial lead placement through thoracoscopy or thoracotomy. PubMedPubMedPacemaker Insertion - StatPearls - NCBI Bookshelf - NIH

If pacing is no longer needed after correction of a reversible cause, remove temporary support promptly rather than maintaining an invasive pacing system solely for observation. If persistent pacing is expected, avoid prolonged right-ventricular temporary pacing when alternatives are clinically feasible because long-term RV pacing has been associated with ventricular dyssynchrony, lower cardiac output, and heart failure. NatureNatureNew drug discovery of cardiac anti-arrhythmic drugs - Nature