Transcutaneous pacing

Transcutaneous pacing (TCP) is a temporary means of pacing a patient's heart during emergencies. It is a non-invasive procedure that uses electrical impulses to stimulate the heart to contract. This method is often used in cases of bradycardia or heart block until a more permanent solution, such as a pacemaker, can be implemented.

Procedure

Transcutaneous pacing involves placing electrode pads on the patient's chest. These pads are connected to an external pacemaker device, which delivers electrical impulses through the skin to the heart. The procedure is typically performed in a hospital setting, often in the emergency department or intensive care unit.

The pacing device is set to deliver impulses at a specific rate and energy level. The goal is to achieve "capture," where the heart responds to the electrical impulses by contracting. The device settings may need to be adjusted to ensure effective pacing.

Indications

Transcutaneous pacing is indicated in several situations, including:

• Symptomatic bradycardia not responsive to atropine
• High-degree atrioventricular block
• Asystole, as a bridge to more definitive treatment

Effectiveness

The effectiveness of transcutaneous pacing is determined by the presence of "capture." True capture is confirmed by observing a corresponding QRS complex on the electrocardiogram (ECG) following each pacing spike. False capture occurs when pacing spikes are present without corresponding QRS complexes.

File:True-capture.png

True capture: Pacing spikes followed by QRS complexes

File:False-capture.png

False capture: Pacing spikes without QRS complexes

Complications

While transcutaneous pacing is generally safe, it can cause discomfort or pain due to the electrical impulses. Other potential complications include skin burns at the electrode sites and interference with other medical devices.

Alternatives

Alternatives to transcutaneous pacing include:

• Transvenous pacing
• Permanent pacemaker implantation

Related pages

• Cardiac pacing
• Electrocardiography
• Cardiac arrest

References

• American Heart Association. "Advanced Cardiovascular Life Support Provider Manual." 2020.
• European Resuscitation Council. "Guidelines for Resuscitation 2021."

• True capture
  True capture
• False capture
  False capture