Transcutaneous pacing

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  1. Bradyarrhythmias causing hemodynamic impairment:[1]
    1. AV block
    2. Sinus node dysfunction
    3. A-fib with slow ventricular response
    4. Malfunction of implanted pacemaker
  2. Tachyarrhythmias causing hemodynamic impairment[1]


  1. Pad placement:
    1. Pad on apex of heart and on right upper chest
    2. Pad on lead V3 position and between left scapula and T-spine
  2. Set: HR 80, pacing threshold usually between 40-80 mA
    1. Look for clear QRS complex and T-wave following pacer spike
    2. Check pulse to confirm mechanical capture
    3. Final current set 5-10 mA above threshold level for patient

See Also


  1. 1.0 1.1 Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. May 27 2008;117(21):e350-408
  • Roberts and Hedges, Clinical Procedures in Emergency Medicine