Noninvasive Transcutaneous Cardiac Pacing: Modern Instrumentation and New Perspectives

Abstract

Noninvasive transcutaneous cardiac pacing has evolved from a simple stand alone unit with no ventricular sensing to a complete cardiac arrest resuscitation system combining synchronous pacing and defibrillation capabilities and using a single set of multifunction electrodes. In current instrumentation, four configurations exist including stand alone unit, modular configuration, built-in monitor and recorder, and built-in monitor, recorder and defibrillator. In present day devices, ventricular sensing, extensive programmability, and large surface electrodes are general features. Capture monitoring requires specific integrated electrocardiographic capability. Future developments are expected to involve low threshold electrode technology, integrated mechanical monitoring, and interdevice electrode compatibility.

Modified Temporary Cardiac Pacing Using Transvenous Active Fixation Leads and External Re-Sterilized Pulse Generators

“…To the Editor: Constrictive pericarditis (CP) often is a challenging diagnosis despite sophisticated modalities (1)(2)(3)(4). If a simple test could alert physicians to the possibility of CP in patients with evidence of heart failure, it would be valuable.…”

Bradyarrhythmias and Physiologic Pacing in the ICU

“…39 Modern external cardioverter-defibrillators come combined with the ability to pace, synchronized cardiovert, and defibrillate without having to change pads making them useful should the patient experience rhythm deterioration. 40 Pacing output in the form of amperage is titrated to achieve myocardial capture at the lowest output, and higher outputs are associated with pectoral stimulation. In some cases, outputs of up to 80 mA (or higher) may be required myocardial for capture.…”

Cardiac Dysrhythmias during Donor Care

“…External, transcutaneous pacing may be considered for treating refractory sinus bradycardia, nonsinus bradycardia, or conduction disorders within the heart if chronotropic medications are ineffective. 31 Rarely, temporary transvenous pacing may be required if medications fail and/or transcutaneous pacing is ineffective. Assistance from a physician is needed for insertion of the pacing wire and initiation of therapy.…”