Name of the Procedure:

Temporary Transcutaneous Pacing

Summary

Temporary transcutaneous pacing is a medical procedure that uses external pads to deliver electrical impulses to the heart through the skin. This helps to manage severe bradycardia (abnormally slow heart rate) or other heart rhythm disorders temporarily until a more permanent solution is implemented.

Purpose

Temporary transcutaneous pacing addresses critical conditions like severe bradycardia or heart block. The goal is to stabilize the patient's heart rate and rhythm to maintain adequate blood circulation and organ perfusion until a more permanent treatment, such as transvenous pacing or a pacemaker implantation, can be arranged.

Indications

• Severe bradycardia (heart rate less than 40 beats per minute)
• Complete heart block
• Symptomatic heart rhythm disorders with hemodynamic instability
• As a bridge until permanent pacing can be established

Preparation

• Patients may be asked to fast for a few hours before the procedure.
• Current medications will be reviewed, and some may need adjustment.
• An electrocardiogram (ECG) and blood tests might be performed prior to the procedure.

Procedure Description

1. The patient will lie down, usually in a supine position.
2. The skin on the chest and back is cleaned and prepared; in some cases, hair might need to be shaved to ensure good contact with the pads.
3. Two adhesive pads (electrodes) are placed on the patient's chest and back.
4. The pacemaker device is connected to the electrodes.
5. The device is programmed to deliver electrical impulses at a predetermined rate and threshold.
6. The patient’s heart rhythm and vital signs are continuously monitored.
7. Adjustments to the pacing rate and output may be made to optimize heart rhythm.

Tools used include adhesive electrode pads and an external pacemaker device. No anesthesia or sedation is typically required, but pain management strategies are available for patient comfort.

Duration

The procedure usually lasts around 30 minutes to an hour, depending on the patient’s condition and responsiveness to pacing.

Setting

Temporary transcutaneous pacing is typically performed in a hospital setting, such as an emergency department, intensive care unit (ICU), or cardiac care unit (CCU).

Personnel

• Cardiologist or Emergency Medicine Physician
• Cardiac Nurse
• Technicians specialized in cardiac procedures

Risks and Complications

• Skin irritation or burns where the electrodes are placed
• Muscular discomfort or spasms
• Failure of the pacing to capture heart rhythm
• Rarely, cardiac arrhythmias or complications from underlying heart conditions

Benefits

• Immediate stabilization of heart rate and rhythm
• Temporary support until permanent pacing solutions are available
• Prevention of hemodynamic collapse and improvement in blood circulation

Recovery

• Continuous monitoring of heart rate and rhythm after the procedure
• Maintenance of the temporary pacing until a permanent solution is ready
• Follow-up assessments and possibly transition to a permanent pacemaker

Alternatives

• Administration of medications to improve heart rate (e.g., atropine, epinephrine)
• Transvenous pacing
• Permanent pacemaker implantation Each alternative has its own risks and benefits which should be discussed with the healthcare provider.

Patient Experience

During temporary transcutaneous pacing, patients may feel mild discomfort or a twitching sensation from the electrical impulses. Post-procedure, skin irritation is possible at the electrode sites. Pain management and comfort measures are provided to ensure patient well-being throughout the process.