• Bradycardia/asystole (sinus or junctional bradycardia or second/third-degree atrioventricular (AV) block) associated with haemodynamic compromise and unresponsive to atropine (Chapter 44).
• After cardiac arrest due to bradycardia/asystole.
• To prevent perioperative bradycardia. Temporary pacing is indicated in:
  • Second-degree Mobitz type 2 AV block or complete heart block
  • Sinus/junctional bradycardia or second-degree Mobitz type I (Wenckebach) AV block or bundle branch block (including bifascicular and trifascicular block) only if there is a history of syncope or presyncope
• Atrial or ventricular overdrive pacing to prevent recurrent monomorphic ventricular tachycardia (Chapter 40) or polymorphic ventricular tachycardia with preceding QT prolongation (torsade de pointes) (Chapter 41).

Contraindications

• Risks of temporary pacing outweigh benefits: for example rare symptomatic sinus pauses, or complete heart block with a stable escape rhythm and no haemodynamic compromise. Discuss management with a cardiologist. Consider using standby external pacing system instead of transvenous pacing.
• Prosthetic tricuspid valve.

Complications

• Complications of central vein cannulation (Chapter 116), especially bleeding in patients with acute coronary syndromes treated with thrombolytic therapy.
• Cardiac perforation by pacing lead (may rarely result in cardiac tamponade).
• Arrhythmias (atrial and ventricular, including tachycardia and ventricular fibrillation) during placement of pacing lead.
• Infection of pacing lead.