What Are the Indications for Transcutaneous Cardiac Pacing?

Transcutaneous cardiac pacing (TCP) temporarily paces a patient’s heart during an emergency and stabilizes them.

Transcutaneous cardiac pacing (TCP) is noninvasive and temporary means of pacing a patient’s heart during an emergency and stabilizing them until a better intervention is achieved.

TCP works as an artificial pacemaker by delivering repetitive electric currents to the heart and thus by increasing the heart rate and heart function.  

Transcutaneous cardiac pacing (TCP) (the fastest method of cardiac pacing) can be used until permanent pacing becomes available. Indications include the following:

• TCP is appropriate when a permanent pacing device is not working or needs to be repaired or changed.
• Patients with a low heart rate
• Patients with a low body temperature
• Patients who undergo cardiac surgery require TCP to determine the functional capacity of the heart.
• Patients who have severe injury to the heart
• Patients who have electrolyte imbalance
• Metabolic and electrolyte derangements
• Patients who are on cardiac-related drugs require TCP as few drugs have side effects of a low heart rate (e.g., digitalis toxicity)
• Diseases such as Lyme disease or bacterial endocarditis
• TCP is also part of advanced cardiac life support during emergency
• TCP is occasionally used to determine whether a patient requires permanent pacing
• Patients with hypotension

Transcutaneous cardiac pacing (TCP) increases a person’s heart rate artificially. Below are the uses of TCP:

• The main use of TCP is when a patient doesn’t require a long-term pacemaker or if a permanent pacemaker is not available. It is also used in patients who are not fit to undergo pacemaker surgery.
• TCP is a temporary method of pacing that is used in patients with symptomatic bradycardia (symptomatic low heart rate).
• It is particularly helpful in patients with reversible or transient conditions (digoxin toxicity and inferior wall myocardial infarction).

Transcutaneous cardiac pacing (TCP) is usually done under local anesthesia or intravenous (IV) sedation. The procedure is completed within an hour depending on the patient’s condition and heart response.

• Patient’s vitals are monitored throughout the procedure.
• The patient would be placed on adequate oxygenation and intravenous saline.
• The patient’s skin on the chest and back may be cleaned.
• TCP equipment consists of a pacing unit, cardiac electrodes (pads), and a cardiac monitor.
• The electrode with negative polarity is usually placed over the cardiac apex (a place where the heartbeat is felt on the chest). 
• The electrode with positive polarity may be placed between the right or left scapula and spine (back of the chest). 
• After skin preparation and application of the pads, the pacemaker is turned on, and the pacing mode may be selected. 
• If the patient has a low heart rate or cardiac rest, pacing may be initiated at the maximum current output to ensure that capture is achieved as soon as possible. Then, the current can be gradually reduced. 
• Cardiac capture should be confirmed by assessing the pulse, blood pressure and clinical status of the patient. 
• In healthy individuals, the pacing threshold is usually less than 80?milliamps.

The risks of transcutaneous cardiac pacing (TCP) include the following:

• Pain
• Anxiety
• Stigma
• Discomfort
• Heart rate may sometimes not respond to TCP

Patients should remember that transcutaneous cardiac pacing (TCP) is a temporary solution for an underlying medical condition. 

• Patients who require a lifelong pacemaker should shift to a regular pacemaker as soon as possible. 
• TCP for expected bradycardia during carotid stenting appeared to be safe and effective in preventing a low heart rate and hypotension during operation, with a decrease in additional medication support during the procedures. 

TCP is primarily used for the treatment of a low heart rate and various types of cardiac diseases. The goal is to provide relief to the patients without major surgery.