Temporary Pacing
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Transvenous cardiac pacing (TVP), also called endocardial pacing, is a potentially life-saving intervention used primarily to correct profound
bradycardia Bradycardia, also called bradyarrhythmia, is a resting heart rate under 60 beats per minute (BPM). While bradycardia can result from various pathological processes, it is commonly a physiological response to cardiovascular conditioning or due ...
. It can be used to treat symptomatic bradycardias that do not respond to
transcutaneous pacing Transcutaneous pacing (TCP), also called external pacing, is a temporary means of pacing a patient's heart during a medical emergency. It should not be confused with defibrillation (used in more serious cases, in ventricular fibrillation and other ...
or to drug therapy. Transvenous pacing is achieved by threading a pacing electrode through a vein into the
right atrium The atrium (; : atria) is one of the two upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the heart ventricles through the atrioventricular mitral and tricuspid heart valves. ...
,
right ventricle A ventricle is one of two large chambers located toward the bottom of the heart that collect and expel blood towards the peripheral beds within the body and lungs. The blood pumped by a ventricle is supplied by an atrium (heart), atrium, an adjace ...
, or both. This means of pacing the heart is not as popular as other means of pacing (like transcutaneous pacing, implanted pacemaker, epicardial pacing) because it is a temporary solution to pace the heart and yet involves a similar level of risk of bleeding as a more permanent solution like placing an implanted pacemaker. For patients who present in an emergency setting with symptomatic bradycardias, usually drugs like
atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically give ...
or sympathomimetic drugs (
epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands a ...
or
dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic chemical of the catecholamine and phenethylamine families. It is an amine synthesized ...
) can be used to increase the heart rate to an adequate level until the underlying cause of the bradycardia can be isolated and then, possibly, a permanent pacemaker can be placed. For patients for whom transvenous pacing is chosen, the procedure is done at the bedside with a
local anesthetic A local anesthetic (LA) is a medication that causes absence of all sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensati ...
alone or in conjunction with
conscious sedation Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decr ...
. The pacing electrode is advanced through the vein under
fluoroscopic Fluoroscopy (), informally referred to as "fluoro", is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a surgeon to see t ...
and
electrocardiographic Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of t ...
guidance. An
X-ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...
after the procedure is always obtained to confirm placement of the pacing electrode. The greater use of atropine and epinephrine or external pacing may make transvenous pacing unnecessary by stabilizing patients early in the process of caring for the patient. Some debate exists over the efficacity and reliability of transvenous pacing, especially if the need for permanent pacing is anticipated.


Notes


References

* Urden, L., Stacy, K., and Lough, M. Thelan's Critical Care Nursing: Diagnosis and Management. Fourth Edition, Mosby, 1998. * Handbook of Emergency Cardiovascular Care for Healthcare Providers. Editors Hazinski, M., Cummins, R., and Field, J. 2004. * {{cite journal , last1=Murphy , first1=JJ , title=Problems with temporary cardiac pacing. Expecting trainees in medicine to perform transvenous pacing is no longer acceptable. , journal=BMJ , date=8 September 2001 , volume=323 , issue=7312 , pages=527 , doi=10.1136/bmj.323.7312.527 , pmid=11546683 , pmc=1121117 Cardiac electrophysiology Emergency medical procedures