Temporary cardiac pacing

ACC/AHA)3 * Asystole * Symptomatic bradycardia (sinus bradycardia with hypotension and type I 2nd degree AV block with hypotension not responsive to atropine) * Bilateral bundle branch block (alternating BBB or RBBB with alternating LAHB/LPHB) * New or indeterminate age bifascicular block with first degree AV block * Mobitz type II second degree AV block - Bradycardia not associated with acute myocardial infarction * Asystole * 2nd or 3rd degree AV block with haemodynamic compromise or syncope at rest * Ventricular tachyarrhythmias secondary to bradycardia - Elective * Support for procedures that may promote bradycardia * General anaesthesia with: 2nd or 3rd degree AV block Intermittent AV block 1st degree AV block with bifascicular block 1st degree AV block and LBBB * Cardiac surgery Aortic surgery Tricuspid surgery Ventricular septal defect closure Ostium primum repair Rarely considered for coronary angioplasty (usually to right coronary artery) - Overdrive suppression of tachyarrhythmias Table 3 Situations where temporary pacing may offer benefit after acute myocardial infarction; placement of transcutaneous electrodes may be more appropriate than transvenous pacing (class II ACC/AHA) 3 Acute myocardial infarction (Class III ACC/AHA)3 * First degree heart block * Type I 2nd degree heart block (Wenckebach) with normal haemodynamics * Accelerated idioventricular rhythm * Bundle branch block or fascicular block known to exist before acute MI - Bradycardia not associated with acute myocardial infarction * Sinus node disease without haemodynamic compromise or syncope at rest * Type II 2nd degree or 3rd degree heart block (constant or intermittent) without haemodynamic compromise, syncope or associated ventricular tachyarrhythmias at rest In the era of thrombolytic treatment, the occurrence of bradycardia often presents a dilemma for the admitting junior doctor. If haemodynamically significant bradycardia continues after institution of thrombolytic treatment, a transvenous temporary pacing electrode should be placed by experienced staff from the external jugular, brachial or femoral route. 4 Practice point Always institute thrombolytic treatment before considering transvenous temporary pacing in the bradycardic patient with an acute myocardial infarction.\n Initial thresholds should be recorded and then checked and recorded at least once daily thereafter by competent staff.