The form should take approximately 1 hour to complete.

You will be able to print your CME certificate immediately.

The credit for the CME activity will be available through June 30, 2013.

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Complications of Cardiac Pacing

Transcutaneous pacing is much safer than transvenous pacing but is not without some complications. Discomfort and skin irritation can be seen, especially with higher-current settings. The majority of transvenous complications are related to central venous access.

They include but are not limited to infection, pneumothorax, air embolism, arterial puncture, and venous thrombosis.

Valvular tears or ruptures and perforations of the ventricular septum, atria, or ventricular free wall have been described and are most commonly seen with rigid catheters. Acute changes in ECG morphology, failure to capture, or sudden decompensation of the patient may be evidence of perforation.

Catheter balloon rupture can result in a pulmonary embolism.

Conclusion

Cardiac pacing has emerged as a life-saving procedure that has found a place in the armamentarium of the emergency physician. Prompt recognition of pacing indications, successful initiation of therapy, and recognition of complications is integral to the successful use of this critical procedure.

References

• Birkhahn RH, et al. Emergency medicine–trained physicians are proficient in the insertion of transvenous pacemakers. Ann. Emerg. Med. 2004;43:469-74.
• Fitzpatrick A, Sutton R. A guide to temporary pacing. BMJ 1992;304:365-9.
• Harrigan RA, et al. Temporary transvenous pacemaker placement in the emergency department. J. Emerg. Med. 2007;32:105-11.
• Labovitz AJ, Noble VE. Focused cardiac ultrasound in the emergent setting: A consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J. Am. Soc. Echocardiogr. 2010;23:1225-30.
• Link MS, et al. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion, and pacing (Part 6). 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122:S706-19.
• Mark J, Hockberger R, Walls R. Rosen’s emergency medicine, 7th ed. Elsevier, 2010.
• Reichman EF, Simon RR. Emergency medicine procedures. McGraw Hill, 2004.
• Zoll PM, Linenthal AJ, Norman LR. Treatment of unexpected cardiac arrest by external electric stimulation of the heart. N. Engl. J. Med. 1956;254:541-6.

Contributor Disclosures

Contributors
Dr. Deal is a third-year resident in the Section of Emergency Medicine at the University of Chicago Medical Center.

Dr. Ahn is a Medical Education Fellow and Clinical Instructor in the Section of Emergency Medicine at the University of Chicago Medical Center. Dr. Wang is a Clinical Associate Professor of Emergency Medicine and the Medical Director for the NorthShore Center for Simulation and Innovation (NCSI) at NorthShore University HealthSystem in Evanston, Ill. Dr. Robert C. Solomon is faculty for the emergency medicine residency at Allegheny General Hospital in Pittsburgh, Pa.