The Dept of Anaesthesia & Intensive Care, CUHK
Transthoracic myocardial puncture
Transoesophageal atrial pacing
DDD pacing. ECG demonstrates sensed p waves with ventricular pacing , atrial pacing spikes with normal conduction, atrial pacing spikes with failure of conduction and subsequent ventricular pacing spikes
Management of failure to pace
Indications in suitable arrhythmias
First two rarely require pacing as they usually respond to adenosine or verapamil. Atrial flutter often resistant to drug therapy. Atrial overdrive pacing will often convert it to SR. Rapid continuous atrial pacing can be used to slow ventricular rate during resistant SVT associated with a rapid ventricular response by inducing AV and a high degree of AV block.
Ventricular overdrive pacing should not be used for very rapid ventricular rate (>300/min) or when severe haemodynamic compromise is present
Should not be attempted without trained assistance and resuscitation equipment
Useful techniques for VT:
Can be programmed to function in a sequential manner so that overdrive pacing is attempted first when VT is sensed, followed if necessary by low and then high energy DC shock. Systems with transvenous leads are now available. Mortality is reduced but remains high.
Donovan KD, Hockings BEF. Cardiac pacing. In Oh TE. Intensive Care Manual 4th ed, 1997
© Charles Gomersall July 1999
May, 2013 unless
otherwise stated. The author, editor and The Chinese University of Hong Kong
take no responsibility for any adverse event resulting from the use of this