Temporary cardiac pacing
- David L Hayes, MD
David L Hayes, MD
- Professor of Medicine
- Mayo Medical School
Temporary cardiac pacing involves electrical cardiac stimulation to treat a bradyarrhythmia or tachyarrhythmia until it resolves or until long-term therapy can be initiated. The purpose of temporary pacing is to re-establish circulatory integrity and normal hemodynamics that are acutely compromised by a slow or fast heart rate. In some situations, temporary pacing can be lifesaving.
This topic will review the indications, contraindications, techniques, and procedural aspects of temporary cardiac pacing. Issues related to permanent cardiac pacing are discussed separately. (See "Modes of cardiac pacing: Nomenclature and selection" and "Permanent cardiac pacing: Overview of devices and indications".)
Any symptomatic indication for permanent cardiac pacing is potentially an indication for temporary cardiac pacing. However, temporary cardiac pacing is most commonly used for patients with symptomatic bradyarrhythmias, most frequently due to atrioventricular (AV) nodal block. When it is evident that a permanent pacemaker is ultimately indicated, many implanting clinicians proceed directly with implantation of a permanent pacemaker. (See 'Temporary versus permanent cardiac pacing as the initial therapy' below and "Permanent cardiac pacing: Overview of devices and indications".)
In general, temporary cardiac pacing is indicated when a bradyarrhythmia causes symptoms and/or severe hemodynamic impairment and when permanent cardiac pacing is not immediately indicated, not available, or the risk of inserting a permanent pacemaker exceeds potential benefit. The main reason for temporary cardiac pacing is to treat severe symptoms and/or hemodynamic instability due to a bradycardia, or to prevent potential deterioration resulting in hemodynamic instability.
Reversible conditions — Temporary cardiac pacing is indicated for bradycardia that results from an acute and reversible cause that will likely not require permanent pacing. This includes:
- Hilling-Smith R, Cockburn J, Dooley M, et al. Rapid pacing using the 0.035-in. Retrograde left ventricular support wire in 208 cases of transcatheter aortic valve implantation and balloon aortic valvuloplasty. Catheter Cardiovasc Interv 2017; 89:783.
- Nalmas S, Nagarakanti R, Slim J, et al. Electrocardiographic changes in infectious diseases. Hospital Physician 2007; 43:15.
- Rosenfeld LE. Bradyarrhythmias, abnormalities of conduction, and indications for pacing in acute myocardial infarction. Cardiol Clin 1988; 6:49.
- Berger PB, Ruocco NA Jr, Ryan TJ, et al. Incidence and prognostic implications of heart block complicating inferior myocardial infarction treated with thrombolytic therapy: results from TIMI II. J Am Coll Cardiol 1992; 20:533.
- O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.
- Yaqub Y, Perez-Verdia A, Jenkins LA, et al. Temporary Transvenous Cardiac Pacing in Patients With Acute Myocardial Infarction Predicts Increased Mortality. Cardiol Res 2012; 3:1.
- Blommaert D, Gonzalez M, Mucumbitsi J, et al. Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery. J Am Coll Cardiol 2000; 35:1411.
- Ferguson JD, Banning AP, Bashir Y. Randomised trial of temporary cardiac pacing with semirigid and balloon-flotation electrode catheters. Lancet 1997; 349:1883.
- Zoll PM, Zoll RH, Falk RH, et al. External noninvasive temporary cardiac pacing: clinical trials. Circulation 1985; 71:937.
- Samuels LE, Samuels FL, Kaufman MS, et al. Temporary epicardial atrial pacing electrodes: duration of effectiveness based on position. Am J Med Sci 1998; 315:248.
- Del Nido P, Goldman BS. Temporary epicardial pacing after open heart surgery: complications and prevention. J Card Surg 1989; 4:99.
- Ferguson TB Jr, Cox JL. Temporary external DDD pacing after cardiac operations. Ann Thorac Surg 1991; 51:723.
- Gallagher JJ, Smith WM, Kerr CR, et al. Esophageal pacing: a diagnostic and therapeutic tool. Circulation 1982; 65:336.
- Kornberger A, Schmid E, Kalender G, et al. Bridge to recovery or permanent system implantation: an eight-year single-center experience in transvenous semipermanent pacing. Pacing Clin Electrophysiol 2013; 36:1096.
- Kawata H, Pretorius V, Phan H, et al. Utility and safety of temporary pacing using active fixation leads and externalized re-usable permanent pacemakers after lead extraction. Europace 2013; 15:1287.
- Aser R, Orhan C, Niemann B, et al. Temporary epicardial pacemaker wires: significance of position and electrode type. Thorac Cardiovasc Surg 2014; 62:66.
- Francis GS, Williams SV, Achord JL, et al. Clinical competence in insertion of a temporary transvenous ventricular pacemaker. A statement for physicians from the ACP/ACC/AHA Task Force on Clinical Privileges in Cardiology. Circulation 1994; 89:1913.
- Brown CG, Hutchins GM, Gurley HT, et al. Placement accuracy of percutaneous transthoracic pacemakers. Am J Emerg Med 1985; 3:193.
- Evans GL, Glasser SP. Intracavitary electrocardiography as a guide to pacemaker postitioning. JAMA 1971; 216:483.
- Ezeugwu CO, Oropello JM, Pasik AS, Benjamin E. Position of temporary transvenous pacemaker after insertion. J Cardiothorac Vasc Anesth 1994; 8:367.
- Goldberger J, Kruse J, Ehlert FA, Kadish A. Temporary transvenous pacemaker placement: what criteria constitute an adequate pacing site? Am Heart J 1993; 126:488.
- Pinneri F, Frea S, Najd K, et al. Echocardiography-guided versus fluoroscopy-guided temporary pacing in the emergency setting: an observational study. J Cardiovasc Med (Hagerstown) 2013; 14:242.
- Guo H, Hahn D, Olshansky B. Temporary biventricular pacing in a patient with subacute myocardial infarction, cardiogenic shock, and third-degree atrioventricular block. Heart Rhythm 2005; 2:112.
- Madershahian N, Scherner M, Weber C, et al. Temporary biventricular pacing improves bypass graft flows in coronary artery bypass graft patients with permanent atrial fibrillation. Interact Cardiovasc Thorac Surg 2015; 21:435.
- Baciewicz FA Jr, Leighton RF, Davis JT. Use of rapid atrial pacing to induce 2:1 atrioventricular block with marked improvement in hemodynamics. Int J Cardiol 1987; 17:327.
- Sheron N, Clarke M. Temporary sequential atrioventricular pacing in myocardial infarction. Postgrad Med J 1987; 63:121.
- Topol EJ, Goldschlager N, Ports TA, et al. Hemodynamic benefit of atrial pacing in right ventricular myocardial infarction. Ann Intern Med 1982; 96:594.
- Scott WA, Lemler M, Farley L, Zehr R. Evaluation of temporary atrial pacing leads. Pacing Clin Electrophysiol 1993; 16:1789.
- Takeda M, Furuse A, Kotsuka Y. Use of temporary atrial pacing in management of patients after cardiac surgery. Cardiovasc Surg 1996; 4:623.
- Ohm OJ, Breivik K, Segadal L, Engedal H. New temporary atrial and ventricular pacing leads for patients after cardiac operations. J Thorac Cardiovasc Surg 1995; 110:1725.
- Moreira DA, Shepard RB, Waldo AL. Chronic rapid atrial pacing to maintain atrial fibrillation: use to permit control of ventricular rate in order to treat tachycardia induced cardiomyopathy. Pacing Clin Electrophysiol 1989; 12:761.
- Hildick-Smith DJ, Petch MC. Temporary pacing before permanent pacing should be avoided unless essential. BMJ 1998; 317:79.
- Silver MD, Goldschlager N. Temporary transvenous cardiac pacing in the critical care setting. Chest 1988; 93:607.
- Rubenfire M, Melean J, Conrad E. Pseudoarrhythmia caused by temporary transvenous pacemaker. JAMA 1976; 235:842.
- Austin JL, Preis LK, Crampton RS, et al. Analysis of pacemaker malfunction and complications of temporary pacing in the coronary care unit. Am J Cardiol 1982; 49:301.
- Hill PE. Complications of permanent transvenous cardiac pacing: a 14-year review of all transvenous pacemakers inserted at one community hospital. Pacing Clin Electrophysiol 1987; 10:564.
- Murphy JJ. Current practice and complications of temporary transvenous cardiac pacing. BMJ 1996; 312:1134.
- Nolewajka AJ, Goddard MD, Brown TC. Temporary transvenous pacing and femoral vein thrombosis. Circulation 1980; 62:646.
- McLeod AA, Jokhi PP. Pacemaker induced ventricular fibrillation in coronary care units. BMJ 2004; 328:1249.
- Reversible conditions
- - Acute myocardial infarction
- - Weighing the benefits of temporary pacing
- Permanent pacemaker system revisions
- Pacing to prevent tachyarrhythmias
- PACING TECHNIQUES
- Temporary versus permanent cardiac pacing as the initial therapy
- Temporary cardiac pacing techniques
- - Transvenous
- - Transcutaneous
- - Epicardial
- - Transesophageal
- Permanent cardiac pacing techniques
- PROCEDURAL ASPECTS OF TEMPORARY TRANSVENOUS PACING
- Vascular access
- Transvenous lead placement
- - Types of transvenous leads
- Connecting the lead and pulse generator
- Pacemaker programming
- POST-PROCEDURE MANAGEMENT
- Immediate post-procedural management
- Management for the duration of temporary pacing
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS