Indications for Emergency Pacing

Emergency cardiac pacing is indicated either therapeutically (for symptomatic bradyarrhythmias) or prophylactically (for conduction defects that pose a high risk of sudden complete heart block or asystole).

As noted before, symptomatic bradyarrhythmias should be treated with atropine and/or isoproterenol as a temporary measure to support cardiac rhythm prior to pacemaker placement. Some patients may respond adequately to atropine alone and do not require pacemaker insertion.

Most authors would recommend prophylactic placement of a pacemaker in any patient with acute myocardial infarction who has a new or age-indeterminant bi- or trifascicular block. In addition, second-degree Mobitz II and, of course, third-degree AV blocks are also indications for pacemaker insertion or transcutaneous pacer pads. Despite successful pacing, many patients with acute myocardial infarction and these serious conduction blocks have extensive left ventricular damage and a high mortality from pump failure.

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