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Temporary transvenous cardiac pacing involves insertion of a pacing wire (catheter based electrode) into the right ventricle to allow electrical stimulation of the myocardium.

Transvenous pacing is usually attempted in the emergency department after less invasive treatments have been unsuccessful. 

Indications

Symptomatic arrhythmia with cardiovascular compromise unresponsive to pharmacotherapy or transcutaneous pacing. 

• Bradyarrhythmias (most common)

  • Sinus bradycardia

  • Sinus arrest

  • Sick sinus syndrome

  • Atrial fibrillation with slow ventricular response

• Atrioventricular block

  • Second degree AV block, Mobitz Type II

  • Complete heart block

• Tachyarrhythmia is a rare indication and maybe attempted under specialist guidance

 

Contraindications

All relative:

• Severe hypothermia – the hypothermic myocardium may be irritable and the introduction of a pacing wire can trigger ventricular fibrillation. In this situation focus on rapid rewarming

• Prosthetic Tricuspid valve

• Insertion through infected skin

• Coagulopathy

 

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Further Reading »

Harrigan RA, Chan TC, Moonblatt S, Vilke GM, Ufberg JW. Temporary transvenous pacemaker placement in the Emergency Department. J Emerg Med. 2007 Jan;32(1):105-11.

Birkhahn RH, Gaeta TJ, Tloczkowski J, Mundy T, Sharma M, Bove J, Briggs WM. Emergency medicine-trained physicians are proficient in the insertion of transvenous pacemakers. Ann Emerg Med. 2004 Apr;43(4):469-74.