Temporary cardiac pacing

A 17-year-old boy took propafenone 3 g and had a sudden cardiac arrest with h5fpotension, left ventricular failure, bradycardia, sinoatrial block, and an atrioventricular junctional and ventricular tachycardia. He was treated with temporary cardiac pacing, catecholamines, and sodium bicarbonate, and the toxicity resolved within 4 hours [66 ]. 

Zoll PM, Zoll RH, Falk RH, et al. External noninvasive temporary cardiac pacing clinical trials. Circulation 1985 71 937. 

Zei PC, Eckart RE, Epstein LM. Modified temporary cardiac pacing using transvenous active fixation leads and external resterihzed pulse generators. J Am Coll Cardiol 2006 47 1487-1489. 

Del Nido P, et al. Temporary epicardial pacing after open heart surgery complications and prevention. J Cardiac Surg 1989 4 99. 

Fig. 10.12 (A) Same patient as Fig. 10.11. Pulmonary capillary wedge pressure shows large cannon waves. Scale 0-40mmHg. (B) Same patient after testing with a temporary dual chamber pacemaker with a physiologic AV delay. Note the normal pulmonary capillary wedge pressure. The patient was markedly improved after the implantation of a dual chamber pacemaker with AV delay optimization. (Barold SS. Acquired Atrioventricular Block. In Kusumoto F, Goldschlager N (Eds), Cardiac Pacing for the Clinician, Philadelphia, PA Lippincott, Williams Wilkins, 2001 with permission).

Management Solution (i) Advanced cardiac life support (ACLS) protocol for complete heart block (CHB) and (ii) turn off tachycardia therapies (iii) turn on temporary pacing in a VOO mode if available (iv) if temporary VOO pacing not available or ineffective, then continue ACLS protocol for CHB as a bridge to emergent reoperation to tighten set screw. 

Pacemakers affected by interference typically respond with temporary loss of output or temporary reversion to asynchronous pacing (pacing at a fixed rate, with no inhibition from intrinsic cardiac events). The usual consequence for the patient is a return of symptoms that originally led to the pacemaker implant, and pacemaker-dependent patients are placed at clinical risk. Pacemaker manufacturers provide extensive information on interference issues via their websites and technical service phone centers. 

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