Surgical Critical Care: Temporary Cardiac Pacing

Indications

• Bradycardia or AV Block:
  • Symptomatic (Most Common Indication)
  • Refractory to Atropine
  • Causing Hemodynamic Instability
• Permanent Pacemaker Indicated but Not Available

Techniques

• Transvenous – Leads Placed into the Right Ventricle Through a Central Venous Catheter
  • Most Common Technique
  • Comfortable & More Durable
  • EKG Will Appear Similar to a Left Bundle Branch Block (LBBB) with Left Axis Deviation
• Transcutaneous/Transthoracic – Adhesive Pads Directly on Chest
  • Most Rapid Initiation
  • Uncomfortable/Painful & Less Durable
  • Only Used as a Temporary Measure for Unconscious Patients with Sedation Until Other Form Available
• Internal Epicardial Leads – Leads Placed into the Epicardium During Cardiac Surgery
  • Only Used for the Initial Days After Surgery
  • Less Durable
• Transesophageal – Leads Placed Through the Esophagus
  • Unreliable & Requires High Current/Pulse Width for Adequate Capture
    • Uncomfortable/Painful
  • Rarely Used