Temporary Cardiac Pacing: Indications, Contraindications and Potential Complications (for Technique, See Chapter 119).*
Indications- Bradycardia/asystole (sinus or junctional bradycardia or second/third-degree AV block) associated with haemodynamic compromise and unresponsive to atropine
- 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 or
- Sinus/junctional bradycardia or second degree Mobitz type I (Wenckebach) AV block or bundle branch block (including bifascicular and trifascicular block) only if history of syncope or presyncope
- Atrial or ventricular overdrive pacing to prevent recurrent monomorphic ventricular tachycardia or polymorphic ventricular tachycardia with preceding QT prolongation (torsade de pointes)
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, especially bleeding in patients with acute coronary syndromes treated with thrombolytic therapy (reduced with ultrasound-guided approach)
- Cardiac perforation by pacing lead (may rarely result in cardiac tamponade)
- Arrhythmias (including ventricular fibrillation) during placement of pacing lead
- Infection of pacing lead
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*Always discuss first with a cardiologist. Where possible, temporary pacing should be avoided, because of the high risk of complications. When bradycardia is likely to be reversible or contraindications to early permanent pacing are present (e.g. sepsis), temporary cardiac pacing may be indicated.
AV, atrioventricular.