Transvenous cardiac pacing (TVP),
also called endocardial pacing, is a potentially life-saving intervention used primarily to correct profound bradycardia. It can be used to treat symptomatic
bradycardias
Bradycardia (also sinus bradycardia) is a slow resting heart rate, commonly under 60 beats per minute (BPM) as determined by an electrocardiogram. It is considered to be a normal heart rate during sleep, in young and healthy or elderly adults, a ...
that do not respond to transcutaneous pacing or to drug therapy. Transvenous pacing is achieved by threading a pacing electrode through a vein into the right atrium, right ventricle, or both.
This means of pacing the heart is not as popular as other means of pacing (see
transcutaneous pacing,
implanted pacemaker
An artificial cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural cardiac pacemaker) or pacemaker is a Implant (medicine), medical device that generates electrical impulses delivered by electrodes to the Heart ...
,
epicardial pacing
The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made of ...
) because it is a temporary solution to pace the heart and yet involves a similar level of risk of bleeding as a more permanent solution like placing an implanted pacemaker.
For patients who present in an emergency setting with symptomatic bradycardias, usually drugs like
atropine
Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically given i ...
or
sympathomimetic
Sympathomimetic drugs (also known as adrenergic drugs and adrenergic amines) are stimulant compounds which mimic the effects of endogenous agonists of the sympathetic nervous system. Examples of sympathomimetic effects include increases in hea ...
drugs (
epinephrine
Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
or
dopamine
Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic compound, organic chemical of the catecholamine and phenethylamine families. Dopamine const ...
) can be used to increase the heart rate to an adequate level until the underlying cause of the bradycardia can be isolated and then, possibly, a permanent pacemaker can be placed.
For patients for whom transvenous pacing is chosen, the procedure is done at the bedside with a local anesthetic alone or in conjunction with
conscious sedation. The pacing electrode is advanced through the vein under fluoroscopic and electrocardiographic guidance. An x-ray after the procedure is always obtained to confirm placement of the pacing electrode.
The greater use of atropine and epinephrine or external pacing may make transvenous pacing unnecessary by stabilizing patients early in the process of caring for the patient. Some debate exists over the efficacity and reliability of transvenous pacing, especially if the need for permanent pacing is anticipated.
Notes
References
* Urden, L., Stacy, K., and Lough, M. Thelan's Critical Care Nursing: Diagnosis and Management. Fourth Edition, Mosby, 1998.
* Handbook of Emergency Cardiovascular Care for Healthcare Providers. Editors Hazinski, M., Cummins, R., and Field, J. 2004.
* {{cite journal , last1=Murphy , first1=JJ , title=Problems with temporary cardiac pacing. Expecting trainees in medicine to perform transvenous pacing is no longer acceptable. , journal=BMJ , date=8 September 2001 , volume=323 , issue=7312 , pages=527 , doi=10.1136/bmj.323.7312.527 , pmid=11546683 , pmc=1121117
Cardiac electrophysiology
Emergency medical procedures