VA ICU Report Pearls 10.9 – Pacing Pearls

Since there were some questions about temporary pacing this morning we thought we would share the following pacing pearls!

Temporary Pacing:

Transcutaneous – described by Dr. Paul Zoll in 1952

-Primary indication: symptomatic bradycardia not responsive to medical treatment

-Contraindicated in: asystolic cardiac arrest, no consensus regarding hypothermic patients

-Pearls: consider sedation because it can hurt, set to 80 bpm capture should occur bw 40 and  80mA

Transvenous Pacing:

-Primary indication: symptomatic bradycardia not responsive to medical treatment, failure of transcutaneous pacing, transvenous pacers have been placed prophylactically in new bundle branch blocks, etc.

-Coagulopathy, anatomic issues (in other words the contraindications to placing the line)

-The procedure of placing the line is similar to a PA catheter placement. L subclavian or R IJ are preferred as these allow the lead to float, with the help of a balloon into the RV. Flouro can be used or the pacer wire can be advanced blindly while watching surface ECG for capture. Placement is verified with X-ray or ultrasound when flouro is not available.

From Deal, Ahn, Wang at http://www.acep.org/Content.aspx?id=80813

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