Understanding Temporary Cardiac Pacing

Methods

There are several techniques for temporary pacing. Which type you have depends on your condition. The methods include:

• Transvenous. Electrodes (leads) are placed directly in the heart using a catheter.

• Epicardial. It's used immediately after heart surgery. The leads are attached to the atrium, ventricle, or both chambers during surgery.

• Transcutaneous. This is used in emergencies. The pacemaker is attached to the outside of the chest wall.

Why the procedure is done

Temporary cardiac pacing may be used in the hospital to control your heart rate when:

• You have a heart rate that's too slow or too fast.

• You have an infection that has interfered with your heart rhythm.

• You had a heart attack that damaged the electrical pathways in your heart. Temporary pacing may be used until the pathway has healed.

• You have a disease or normal aging has damaged the electrical pathway. Temporary pacing may be used until you can get a permanent pacemaker.

• You need a short-term treatment until medicines take effect.

• You have open heart surgery and need help for a few days to keep your heart rhythm normal.

How is transvenous cardiac pacing done?

• You will be given a medicine to numb the skin where the catheter will be inserted. You'll also get a sedative to help relax you for the procedure.

• Your skin will be cleaned.

• For any type of pacemaker, an electrode lead from the pacemaker to the heart is placed. For a transvenous pacemaker, the lead is placed using a catheter through a large vein in the neck, chest, or groin. The lead is then advanced through the vein to the heart using fluoroscopy (a real-time, live X-ray) to guide it.

• The pacemaker is worn outside your body on your arm, close by your bedside, or in a pouch and connected to your hospital gown.

• The pacemaker is programmed to the right pacing for you, and the insertion site is bandaged.

Risks of the procedure

Risks of transvenous cardiac pacing include:

• Problems with anesthesia.

• Bleeding.

• Blood clots.

• A collapsed lung.

• Infection.

• The lead dislodging from its connection point.

• The catheter poking a hole in the heart or the vein.

• Catheter positioning problems.

How is epicardial pacing done?

Epicardial cardiac pacing is used following heart surgery. Leads are connected to the atrium, the ventricle, or both chambers. This is done after the surgery is finished and before the chest is closed. Wires go outside the chest and are connected to an external pacemaker box.

Risks of the procedure

Risks of epicardial pacing include:

• Damage to the muscle tissue of the heart.

• Infection.

• Irregular heart rhythm (arrythmia).

• The leads poking a hole in the heart.

• Fluid buildup around the heart that puts extra pressure on the heart (cardiac tamponade).

How is transcutaneous pacing done?

Transcutaneous pacing is done when urgent pacing is needed. Sticky pads holding the electrodes are stuck to the outside of your chest to pace the heart through the chest wall. Pacing can be difficult using this method and may be uncomfortable. You may be given medicine to reduce the discomfort or a sedative to help relax you for this procedure.

Risks of the procedure

Risks of transcutaneous pacing include:

• Skin burns.

• Muscle contractions.

• Pain.

• Failure to pace the heart.

After the procedure

Here's what will happen after the procedure:

• You will be checked frequently by a nurse or other health care providers.

• You will be on a continuous heart monitor.

• Don’t pull on the wires. This can dislodge them.

• Your movement may be limited while you have the temporary pacemaker.

• You will not be able to shower. Ask your provider when you can take a sponge bath.

• Keep mobile phones and electronic devices away from you. They may interfere with the pacing unit.

• Your movement may be limited while you have the temporary pacemaker.