Transvenous pacing

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Temporary transvenous cardiac pacing, also called endocardial pacing, is a potentially life saving intervention used primarily to correct profound bradycardia. It can be used to treat symptomatic bradycardias that do not respond to transcutaneous pacing or to drug therapy. Transvenous pacing is acheieved by threading a pacing electrode through a vein into the right atrium, right ventricle, or both.

This means of pacing the heart is not as popular as other means of pacing ( see transcutaneous pacing, implanted pacemaker, epicardial pacing ) because it is a temporary solution to pace the heart and yet involves a similar level of risk of bleeding as a more permanent solution like placing an implanted pacemaker.

For patients who present in an emergency setting with symptomatic bradycardias, usually drugs like atropine or sympathomimetic drugs (e.g. epinephrine, vasopressin, etc.) can be used to increase the heart rate to an adequate level until the underlying cause of the bradycardia can be isolated and then, possbibly, a permanent pacemaker can be placed. In most patients, transcutaneous pacing would be attempted before transvenous pacing because of the ease and speed of its application and its relative lack of risk.

For patients for whom transvenous pacing is chosen, the procedure is done at the bedside with a local anesthetic alone or in conjunction wtih conscious sedation. The pacing electrode is advanced through the vein to the heart with the guidance of an electrocardiogram and sometimes with ultrasonography. An x-ray after the procedure is always obtained to confirm placement of the pacing electrode.

The greater use of atropine and epinephrine or external pacing may obviate the need for transvenous pacing by stabilizing patients early in the process of caring for the patient. Some debate exists over the efficacity and reliability of transvenous pacing, especially if the need for permanent pacing is anticipated.

[edit] References

1. Urden, L., Stacy, K., and Lough, M. Thelan's Critical Care Nursing: Diagnosis and Management. Fourth Edition, Mosby, 1998. ISBN 0-323-01461-5
2. Handbook of Emergency Cardiovacular Care for Healthcare Providers. Editors Hazinski, M., Cummins, R., and Field, J. 2004. ISBN 0-87493-448-6
3. Murphy, J. J. Problems with temporary cardiac pacing. British Medical Journal. 2001 September 8; 323(7312): 527.