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Electrophysiology 102: modes of pacing

By far the most important mode of pacing that we utilize emergently in the ED is VOO. In this mode we just overdrive pace the ventricle. Typically these are patients with bradycardia and/or hypotension/AMS. Occasionally, you may see intermittent asystolic events due to profound heart block. Both of these patients need to have transvenous pacing until electrophysiology can place a permanent pacemaker. You can let them figure out the mode that best suits them. Penultimate final point for patients with a pacemaker who come in unstable: if you a put a magnet on the pacemaker it will default the pacemaker to AOO, VOO, or DOO (all overdrive pacing). No response to this means dead battery or lead…

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 Overdrive Pacing: Exploring the Purpose and Function of Cardiac Overdrive Pacing

The primary purpose of overdrive pacing is to: (1) Terminate atrial or ventricular tachyarrhythmias: By delivering rapid electrical impulses, overdrive pacing can disrupt the abnormal electrical pathways responsible for tachyarrhythmias, restoring the heart's normal rhythm. (2) Control heart rate: Overdrive pacing can help regulate the heart rate in cases of bradycardia (slow heart rate) by providing a faster pacing rate than the intrinsic rhythm. (3) Prevent tachycardia-induced cardiomyopathy: Prolonged periods of rapid heart rate can lead to tachycardia-induced cardiomyopathy, a condition characterized by impaired heart function. Overdrive pacing can help prevent or reverse this condition…

Articles of Interest

ECG Pointers: Recurrent and Refractory Torsades de Pointe

Electrically pace the heart to decrease the QT interval. Electrical overdrive pacing with transcutaneous or transvenous stimulation has significantly improved capture. Some experts advocate that even when a patient has been controlled chemically, this should only be a bridge to electrical pacing4. The pacing mode should be set to asynchronous, also known as fixed rate, with the same target as above (90-110 bpm). Start at a high rate and titrate down.

Overdrive Pacing

RHYTHMS THAT CAN BE CONTROLLED: AV junctional tachycardia. paroxysmal re-entrant SVT. atrial flutter (rate 320-340). SVT with rapid ventricular response that fails to revert. VT (may precipitate VF).

Resistant Ventricular Arrhythmia and the Role of Overdrive Pacing in the Suppression of the Electrical Storm

In severe cases of electrical storm that is refractory to the initial management, overdrive pacing is a helpful temporary method in the stabilization of the case and it could be a very important early tool to decrease the mortality in resistant arrhythmia after myocardial infarction.

Termination of drug-induced torsades de pointes with overdrive pacing

Drug-induced prolongation of the QT interval is frequently encountered after medication overdose. Such toxicity can result in degeneration to torsades de pointes (TdP) and require overdrive pacing. Although rarely encountered, patients with drug-induced TdP can be successfully managed with overdrive pacing.

Resources

StatPearls

Temporary cardiac pacing (TCP) is a type of exogenous cardiac pacing in which an external energy source delivers electrical impulses to stimulate the heart to contract faster than its native rate. This intervention can be used to over-ride a malignant tachydysrhythmia or compensate for symptomatic bradycardia. TCP is typically used for dysrhythmias refractory to pharmacological therapies or cardioversion.