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Transvenous Pacing (Temporary)
Related Subjects: Atropine |Acute Anaphylaxis |Basic Life Support |Advanced Life Support |Adrenaline/Epinephrine |Acute Hypotension |Cardiogenic shock |Distributive Shock |Hypovolaemic or Haemorrhagic Shock |Obstructive Shock |Septic Shock and Sepsis |Shock (General Assessment) |Toxic Shock Syndrome
⚡ Temporary pacing wires are always considered a “dirty procedure.” 👉 If the patient is stable, it is usually safer to delay and implant a permanent pacing system electively. 🚑 Always seek senior advice if unsure.
📌 Indications
- Asystolic cardiac arrest with persisting P-wave activity
- High-degree atrioventricular (AV) block in the setting of acute myocardial infarction
- High risk of developing symptomatic bradycardia during an interventional/surgical cardiac procedure
- Failure of transcutaneous pacing with electrode pads
- Maintain HR 85–100 bpm in order to suppress torsades de pointes
🛠️ Method
- Requires central venous access. Typical entry sites:
- Right Internal Jugular vein
- Right Subclavian vein
- Right Femoral vein
- Insert a venous sheath large enough to pass the pacing wire. Aim to place the tip in the apex of the right ventricle (trial and error often required).
- Set pacing rate initially to ~70/min.
- Gradually increase output voltage - most patients capture at ~3–4 V. ➡️ Once capture is achieved, program output at ~2 × threshold (or at least above it).
- Check pacing threshold daily, as thresholds often rise post-procedure → may need repositioning.
- Confirm capture on ECG before leaving the patient.
⚠️ Complications
- Failure of placement → urgent help required
- Pneumothorax (esp. with subclavian approach)
- Infection and sepsis (strict asepsis required)
- Cardiac perforation → tamponade
- Pacing failure (loss of capture, lead displacement, wire fracture)
📊 Diagrams
📚 References
💡 Exam Pearl: Always think: indication, access site, threshold check, complications. If the patient is stable, defer to permanent pacing rather than risking infection or displacement with a temporary wire.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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