II. Indications
- Refractory Unstable Bradycardia
- Third Degree Atrioventricular Block
- Torsades de Pointes (Overdrive Pacing)
III. Technique
- Apply pacer pads (Defibrillator/cardioversion pads) in Anterior-Posterior Positioning
- Connect pads to monitor
- Start Procedural Sedation and Analgesia (current >50 mA is intolerable without sedation)
- Turn pacing rate to 60 to 80 bpm or (>30 beats per minute above the patient's intrinsic Heart Rate)
- Set the current starting at 10 mA and increase in 10 mA intervals until capture is indicated on the monitor
- Current of 50 to 100 mA is usually required
- Increase current 10 mA above the capture threshold
- If capture is not reached by current of 120 to 130 mA, stop, reposition pads, and restart at 70 mA
IV. Resources
- Transcutaneous Pacing (Nickson, Life in the Fastlane)
- Transcutaneous Pacing (Open Anesthesia)
