What are the indications for temporary emergency pacing?

Updated: Oct 11, 2019
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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Temporary emergency pacing is indicated for therapy of significant and hemodynamically unstable bradyarhythmias and for prevention of bradycardia-dependent malignant arrhythmias. Examples include refractory symptomatic sinus node dysfunction, complete heart block (see the image below), alternating bundle-branch block, new bi-fascicular block, and bradycardia-dependent ventricular tachycardia. 

Third-degree heart block. Image courtesy of James Third-degree heart block. Image courtesy of James Heilman, MD, via Wikimedia Commons.
Electrocardiogram showing complete heart block. Th Electrocardiogram showing complete heart block. The ventricular rate is 25 per minute, the QRS complex is very wide, and there is atrioventricular dissociation. Image courtesy of Case Reports in Cardiology ((Jafar NS, et al. Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis. Case Rep Cardiol. 21 Aug 2014; Article ID 372936).

Examples of indications for prophylactic temporary pacing include for the purpose of transcatheter aortic valve replacement (TAVR), use of medications that may cause or exacerbate hemodynamically significant bradycardia, prophylaxis during the perioperative period surrounding cardiac valvular surgery, Lyme disease or other infections (Chagas disease) that cause interval changes.

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