Transcutaneous Pacemaker Stimulation

Transcutaneous pacemaker stimulation is a replacement therapy until an intravenous or definitive subcutaneous pacemaker is available ("bridge device"). Transcutaneous pacemaker stimulation can be used effectively when used correctly, but requires precise knowledge of the system and permanent monitoring of the patient.

Procedure for transcutaneous pacemaker stimulation:'

1. Check electrodes for their expiration date... # Expired electrodes must not be used under any circumstances, as there is a high probability (!!!) of ineffective stimulation. # Shave skin and degrease electrodes with the electrode cable before applying the electrodes # Attach electrodes firmly with the electrode cable # Anterior electrode over the tip of the heart, posterior electrode posterior 2-3 transverse fingers under the scapula # Inform patients about painful stimulation and use analgesics (morphine) and possibly additional analgesics (morphine). Have benzodiazepine ready and administer later as required # Switch on pacemaker # Set stimulation mode, usually VVI or Demand (depending on the device; this means that the pacemaker stimulates in the ventricle [V], perceives impulses in the ventricle [V] and that the stimulation is inhibited [I] if one's own ventricle impulse is perceived; Demand = demand controlled.) # Set frequency 70 (or 80) # Slow increase of the impulse current until effective stimulation (analgesia!) in awake patients. The resuscitation starts with the highest pulse current. NOTE: Effective stimulation should not be assessed by ECG alone. A pulse keying is indispensable! # Stimulus threshold test and final adjustment of the pulse current strength:

The lowest pulse current required for effective stimulation is the stimulation threshold. One

Safe stimulation can only be guaranteed above the stimulation threshold. The double

Impulse energy would be recommended if it is tolerated by the patient under analgesia.

1. Sensing threshold test:

To make sure that the pacemaker recognizes his own heart actions and does not

the sensitive phase of the pacemaker should be stimulated as much as possible.

can be set low. In practice, it is only possible to check the sensing threshold if

although faster eigenrhythms than the lowest adjustable pacemaker frequency are present. The pacemaker device switches to this lowest frequency (idR. 30min) and slowly increases the sensing in milliVolt until the own actions are no longer recognized and the pacemaker stimulates with 30 independent of the own actions of the heart. The highest setting at which self actions have just been detected is the sensing threshold. The final setting should be at half of the sensing threshold to enable the detection of extrasystoles with possibly lower potentials. The setting should not be too low to avoid inhibition of the pacemaker by muscle potentials.