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:
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- 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
- SUMMARY AND RECOMMENDATIONS