Atrial Overdrive Pacing (Perform)
PREREQUISITE NURSING KNOWLEDGE
• Knowledge of the anatomy and physiology of the cardiovascular system, principles of cardiac conduction, and basic and advanced dysrhythmia interpretation is necessary.
• Knowledge of pacemaker function and patient response to pacemaker therapy is needed.
• Principles of general electrical safety need to be applied with use of temporary invasive pacing.
• Gloves always should be worn when handling pacemaker electrodes to prevent microshock because even small amounts of electrical current can cause serious dysrhythmias if they are transmitted to the heart.
• Clinical and technical competence related to the use of a temporary atrial pacemaker pulse generator and the rapid atrial pacing feature is needed (Fig. 48-1).
• Advanced cardiac life support knowledge and skills are necessary.
• Supraventricular dysrhythmias (e.g., atrial flutter, reentrant atrial tachycardia, atrioventricular [AV] nodal reentry tachycardia, reentrant tachycardias that use an accessory pathway, such as Wolff-Parkinson-White [WPW] syndrome) sometimes can be terminated by overdrive atrial pacing.
• Atrial fibrillation occasionally terminates with overdrive atrial pacing, but this is not a reliable therapy for atrial fibrillation.
• Overdrive atrial pacing is performed most commonly with epicardial atrial pacing wires placed during cardiac surgery. A transvenous atrial pacing lead with an active fixation tip to help keep the lead in the atrium also can be used.
• Overdrive atrial pacing involves the delivery of short bursts of rapid pacing stimuli through an epicardial atrial pacing wire or a transvenous lead in the atrium. The physician or advanced practice nurse determines the duration and rate of the burst.
One approach to overdrive pacing is to atrial pace the heart with 20 milliampere (mA) at a rate 20% to 30% faster than the intrinsic atrial rate for 30 seconds, then stop pacing. An alternate approach is to initiate atrial pacing at a rate 20 beats/min faster than the intrinsic atrial rate; if 1:1 capture does not occur after 30 seconds, the paced rate can be increased by 20 beats/min; repeat every 30 seconds until 1:1 capture is achieved. Continue pacing until the heart rate decreases from AV block (e.g., 2:1, 3:1) or 1 to 2 minutes of 1:1 pacing have occurred, then stop pacing.6
Successive bursts usually are performed at gradually increasing rates (maximal capability of the pulse generator for overdrive atrial pacing is 800 pulses/min) and may be delivered for up to 2 minutes.7
• The atrial pacing wire or atrial pacing lead needs to be accurately identified with initiation of overdrive pacing because pacing the ventricle at rapid rates may result in ventricular tachycardia or ventricular fibrillation.
• Rapid atrial pacing may result in degeneration of the atrial rhythm to atrial fibrillation with a rapid ventricular response. This pacemaker-induced atrial fibrillation usually does not sustain itself for more than a few minutes before it converts to normal sinus rhythm.6
• If an accessory pathway is present, rapid atrial pacing can result in conduction to the ventricles over the accessory pathway, leading to ventricular fibrillation.
• Overdrive suppression of the sinus node may result in periods of bradycardia, asystole, junctional or ventricular escape rhythms, or polymorphic ventricular tachycardia on termination of the atrial overdrive pacing and the atrial tachydysrhythmia.
• Conversion of an atrial tachydysrhythmia can result in dislodgment of atrial thrombus and embolization of clots to the pulmonary or systemic circulation.
EQUIPMENT
• External pulse generator capable of rapid atrial pacing
Related posts:
36: Standard Weaning Criteria: Negative Inspiratory Force or Pressure, Positive Expiratory Pressure, Spontaneous Tidal Volume, Vital Capacity, and Rapid Shallow Breathing Index
103: Peripheral Nerve Blocks: Assisting with Insertion and Pain Management
117: Bone Marrow Biopsy and Aspiration (Perform)
29: Arterial-Venous Oxygen Content Difference and Oxygen Transport (Delivery) and Consumption Calculations
118: Bone Marrow Biopsy and Aspiration (Assist)
115: Use of a Massive Infusion Device and a Pressure Infusor Bag
