Temporary cardiac pacing: modes, evaluation of function, equipment, and trouble shooting

Artificial cardiac pacing has become a sophisticated therapeutic and diagnostic tool in the management of arrhythmic cardiac emergencies. Major innovations have occurred in the last three decades since the advent of temporary pacing, and today, pacing can be effected "physiologically" in both chambers. This has been the result of improved venous access techniques, technologic improvements in electrode design, and the development of sophisticated external pulse generators. It has become clear that ventricular pacing alone does not improve the hemodynamic derangement consequent upon ventricular bradycardia and AV dyssynchrony. The restoration of AV synchrony either by atrial pacing preceding ventricular events or by ventricular pacing at a defined AV delay following a sensed atrial event (P wave) can often reverse the hemodynamic derangement and result in both extension of life and more rapid reversal of the clinical compromise in certain cases of acute heart block. Temporary pacing has always been used for bradyarrhythmias, but more recently, antitachycardia pacing is being utilized increasingly in the acute care setting.