![]() “Burns to be alive: a complication of transcutaneous cardiac stimulation.” Critical care (London, England) vol. “Complications and Outcomes of Temporary Transvenous Pacing: An Analysis of > 360,000 Patients From the National Inpatient Sample.” Chest vol. “Temporary Cardiac Pacing.” UpToDate, 1 Mar. “Using transcutaneous cardiac pacing to best advantage: How to ensure successful capture and avoid complications.” The Journal of critical illness vol. “Thermal burn resulting from prolonged transcutaneous pacing in a patient with complete heart block.” The American journal of emergency medicine vol. The complications found from this study are detailed in the chart below.Ĭarrizales-Sepúlveda, Edgar Francisco et al. The researchers found that overall, in-hospital mortality was 14.1% and 37.9% of patients required permanent pacemaker placement. A study by Metkus (2019) tracked patient outcomes post transvenous cardiac placement in 360,223 patients between 20. ![]() ![]() Complications are broad and include infection, arterial injury, bleeding, pulmonary embolism, pneumothorax, air embolism, catheter knotting, myocardial perforation, lead dislodgement and disconnection, extracardiac stimulation and various arrhythmias including ventricular tachycardia and ventricular fibrillation. Complications from transvenous pacing are due to venous access, the transvenous pacing lead or the external electromagnetic interference. ![]() This method does not come without its drawbacks, especially since it is invasive in nature, and complications can arise from a variety of causes. The preferred method for temporary cardiac pacing in most patients is transvenous pacing largely due to patient comfort and durability over time. To minimize this complication, the patient’s skin should be inspected frequently and electrodes repositioned as necessary. This complication is more common in children, however, both Carrizale-Sepulveda (2018) and Muschart (2014) document case studies in which a patient had a third-degree burn post transcutaneous pacing. Although rare, a more serious complication of transcutaneous pacing includes skin burns. Underlying conditions such as pericardial effusion, pneumothorax, myocardial ischemia or metabolic derangement may raise the pacing threshold or effect ability the to capture, thus correcting these conditions is important in management of the patient. Furthermore, in cases with prolonged pacing, the pacing threshold may change resulting in failure to capture and can be corrected by increasing the threshold. Additionally, there could be poor contact between the skin and the electrode secondary to sweat, hair or debris which can be avoided via hair trimming and proper cleaning and drying of area prior to electrode placement. This can easily be corrected by avoiding bony structures and correct placement of the negative electrode anteriorly. There are many reasons the electrodes may have failure to capture with one of the most common being suboptimal placement of the electrodes. Failure to capture is another common complication. Proper sedation with benzodiazepine and analgesia with opiates are essential for patient undergoing transcutaneous pacing to lessen discomfort and pain until transvenous pacing can be initiated. The pain that occurs from transcutaneous pacing primarily is the result of muscle contractions from the high current output levels. Other complications include failure to capture and skin burns. There are many advantages to transcutaneous pacing such as wide availability, ease of use, quick deployment and decreased risk of serious complications in comparison to invasive techniques such as transvenous pacing, however, pain secondary to electrical induced muscular contraction is a big drawback to this method. In this blog post, the complications of both transcutaneous and transvenous cardiac pacing are discussed. ![]() Although there are no absolute contraindications to temporary pacing in patients with a symptomatic bradyarrhythmia and life-threatening hemodynamic instability, temporary pacing does not come without risks. Transvenous pacing is the preferred approach as it is more comfortable for the patient and more durable overall. Transcutaneous pacing is the most immediate method to provide temporary pacing, however, it can be highly uncomfortable for the patient and its efficacy varies. The two main types of temporary cardiac pacing include transcutaneous and transvenous pacing. Temporary cardiac pacing is utilized to reestablish circulatory integrity and normal hemodynamics in cases of bradyarrhythmia until resolution or initiation of long-term therapy. ![]()
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