Temporary Cardiac Pacing in the Intensive Care Unit

Abstract

Indications for temporary cardiac pacing have increased substantially in the last several years. Although most temporary cardiac pacing is still carried out to treat symptomatic bradycardia due to atrioventricular conduction system disease or atrial bradycardia (i.e., sinus node dysfunction), temporary pacing is currently used to induce and to terminate some supraventricular tachyarrhythmias, prevent pause-dependent ventricular tachycardia (usually torsades de pointes), and vagally mediated atrial fibrillation, to allow the maintenance of hemodynamic competence in postoperative cardiac patients and to evaluate selected patients with hypertrophic and dilated cardiomyopathies who might benefit hemodynamically from cardiac pacing. The roles of transcutaneous and esophageal pacing have also expanded; transcutaneous pacing is now commonly used in patients at high risk for the development of atrioventricular block, such as those with acute myocardial infarction and bifascicular block. We review available types of temporary pacing leads and pulse generators, the methods by which temporary pacing is accomplished, complications of pacing system insertion, and current indications for this therapy. Guidelines for troubleshooting normal and abnormal pacemaker function in the intensive care unit setting are provided.