UMEM Educational Pearls

Category: Critical Care

Title: Pacer Pad Placement for TCP

Posted: 11/29/2022 by Mike Winters, MD (Updated: 1/27/2023)
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Transcutaneous Cardiac Pacing

  • Transcutaneous cardiac pacing (TCP) is often attempted while preparing for transvenous cardiac pacing in critically ill patients with symptomatic bradycardia unresponsive to medical therapy.
  • For TCP, pacer pads can be placed in either the anterolateral (AL) or anteroposterior (AP) positions.  
  • Current resuscitation guidelines from the American Heart Association and the European Resuscitation Council do not identify a preferred pacer pad placement for TCP.
  • In a recent study of patients who received TCP following cardioversion from atrial fibrillation or flutter, Moayedi and colleagues found that pacer pads placed in the AP position required less mA to capture and chest wall contractions were less severe when compared to the AL position.
  • In fact, capture was approximately 80% more likely with pacer pads placed in the AP position compared to the AL position.
  • Take Home Point: Consider placing the pacer pads in the AP position the next time you need to initiate TCP.

References

Moayedi S, et al. Anteroposterior pacer pad position is better than anterolateral for transcutaneous cardiac pacing. Resuscitation 2022; 181:140-6.

Moayedi S, et al. Anteroposterior pacer pad position is more likely to capture than anterolateral for transcutaneous cardiac pacing. Circulation. 2022; 146:1103-4.