Temporary cardiac pacing: electrical stimulation to heart to treat tachyarrhythmia or bradyarrhythmia

Transcutaneous: pacing through the skin

  • Complications: significant pain (requires sedation), decreased reliability

Transvenous: Insert through left subclavian vein or the right internal jugular vein. In the ED, we generally only use ventricular pacing but it is possible to also pace from the atrium

  • Complications
  • Once a pacemaker is inserted a patient may become rapidly dependent on it resulting in asystole if pacemaker is dislodged which may have not happened prior to insertion of temporary pacemaker
  • Infection
  • Pneumothorax
  • Cardiac perforation
  • Tamponade
  • Bleeding
  • PE
  • Air embolism

Indications: bradyarrhythmia with hemodynamic impairment, lyme carditis, injury to sinus/AV node/his-Purkinje system, heart transplantation, cardiac trauma, drug induced (calcium channel blockers, digoxin, beta blockers, amiodarone), electrolyte imbalance (hyperkalemia), acute MI resulting in conduction abnormality, failure of permanent pacemaker, sick sinus syndrome, ventricular tachyarrhythmias

Relative contraindications – risks > benefits, intermittent/mild symptoms in bradycardia, prosthetic tricuspid valve, MI where a thrombolytic has been given (increased risk of bleeding)