PACING FAILURE TO CAPTURE HOW TO
PACING FAILURE TO CAPTURE SKIN

Symptomatic second-degree AV block (type I or II) Severe symptomatic or hemodynamically unstable bradyarrhythmiasĬomplete or third-degree AV block with symptoms (syncope, pre-syncope, dizziness)Ĭomplete AV block with asystolic pauses exceeding 3 secondsĬomplete AV block with escape pacemaker rate < 40 beats/min In addition, transcutaneous pacing has been used in patients with asystolic cardiac arrest (asystole). The hemodynamically significant bradyarrhythmias that often require temporary pacing include various types of acquired AV block, sinus node dysfunction, and symptomatic bifascicular block ( Table 1). 4- 8 It is often used as a bridge to temporary transvenous pacing or to a permanent pacemaker, and it should not be relied on if temporary pacing is required for a prolonged period. It is particularly helpful in reversible or transient conditions (such as digoxin toxicity and atrioventricular block in the setting of inferior wall myocardial infarction ) or when transvenous pacing is not immediately available or carries a high risk of complications. In general, external pacing is indicated as a temporary method of pacing in patients with severe symptomatic or hemodynamically unstable bradyarrhythmias, particularly in those who do not respond to pharmacologic therapy (such as atropine). Transcutaneous cardiac pacing is a temporary method of pacing indicated in various clinical settings, including some cardiac emergencies.

PACING FAILURE TO CAPTURE HOW TO

In this article, we will review the indications and techniques for transcutaneous pacing and how to avoid complications.

Noninvasive pacing carries a much smaller risk of serious complications compared with invasive techniques, and it is more cost-effective. Because it can be performed quickly, noninvasive pacing can be initiated almost immediately, eliminating the setup and the insertion time of invasive techniques (transvenous and epicardial pacing). It is easy to perform and requires minimal training and, therefore, may be instituted by physicians, nurses, and paramedics. It is widely available on most crash carts, along with defibrillator units. 2, 3 Technical advances, including large adhesive electrodes and ECG filtering, have largely overcome the early problems of extreme discomfort and interpretation of capture on the ECG.Įxternal noninvasive pacing offers several advantages over invasive pacing. As a result, noninvasive pacing reemerged, in the 1980s, as a therapy for bradycardia and asystole. Transvenous pacing has served as the mainstay of urgent temporary pacing since then, although the significant time and operator skill needed to implement the technique are less than ideal. With the development of transvenous pacing leads later in the 1950s, interest in external pacing waned.

PACING FAILURE TO CAPTURE SKIN

However, the high current densities that the skin electrodes required to pace the cardiac tissue in those early devices caused painful stimulation of the cutaneous nerves and underlying skeletal muscles. Transcutaneous pacing was first introduced by Zoll and associates 1 in 1956 as a novel method of treating asystole and significant bradyarrhythmias. Adequate sedation and analgesia are essential in ensuring patient comfort.

Proper skin preparation and electrode positioning ensure successful capture in most situations. The hemodynamic response to pacing also must be confirmed by assessing the patient’s arterial pulse. On electrocardiography, successful capture usually is characterized by a widened QRS complex, followed by a distinct ST segment and broad T wave. Most patients with minimal hemodynamic compromise require a current of 40 to 80 mA pacing thresholds tend to be higher in patients who have emphysema or pericardial effusion and in those who receive positive pressure ventilation. It is particularly helpful in patients with reversible or transient conditions, such as digoxin toxicity and atrioventricular block in the setting of inferior wall myocardial infarction, or when transvenous pacing is not immediately available or carries a high risk of complications. Transcutaneous cardiac pacing is a temporary method of pacing that may be indicated in patients with severe symptomatic or hemodynamically unstable bradyarrhythmias.

Pacing failure to capture