Transcutaneous pacing

True electrical and mechanical capture

Transcutaneous pacing (TCP), also called external pacing, is a temporary means of pacing a patient's heart during a medical emergency. It should not be confused with defibrillation (used in more serious cases, in ventricular fibrillation and other shockable rhythms) using a manual or automatic defibrillator, though some newer defibrillators can do both, and pads and an electrical stimulus to the heart are used in transcutaneous pacing and defibrillation. Transcutaneous pacing is accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract.[citation needed]

The most common indication for transcutaneous pacing is an abnormally slow heart rate. By convention, a heart rate of fewer than 60 beats per minute in the adult patient is called bradycardia.[1] Not all instances of bradycardia require medical treatment. Normal heart rate varies substantially between individuals, and many athletes in particular have a relatively slow resting heart rate.[2] In addition, the heart rate is known to naturally slow with age. It is only when bradycardia presents with signs and symptoms of shock that it requires emergency treatment with transcutaneous pacing.

False capture with visible phantom beats[3]

Some common causes of hemodynamically significant bradycardia include myocardial infarction, sinus node dysfunction and complete heart block.[citation needed]

Transcutaneous pacing is no longer indicated for the treatment of asystole (cardiac arrest associated with a "flat line" on the ECG), with the possible exception of witnessed asystole (as in the case of bifascicular block that progresses to complete heart block without an escape rhythm).[4]

  1. ^ Mangrum, J. Michael; DiMarco, John P. (2000-03-09). "The Evaluation and Management of Bradycardia". New England Journal of Medicine. 342 (10): 703–709. doi:10.1056/NEJM200003093421006. ISSN 0028-4793. PMID 10706901.
  2. ^ Carter, James B.; Banister, Eric W.; Blaber, Andrew P. (2003-01-01). "Effect of Endurance Exercise on Autonomic Control of Heart Rate". Sports Medicine. 33 (1): 33–46. doi:10.2165/00007256-200333010-00003. ISSN 1179-2035. PMID 12477376. S2CID 40393053.
  3. ^ "Transcutaneous Pacing (TCP): The Problem of False Capture". EMS 12 Lead. Retrieved 2019-01-31.
  4. ^ GREGORATOS, GABRIEL. "ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices" (PDF).