[Thoracic transcutaneous cardiac pacing].
Transcutaneous cardiac pacing was abandoned when endocardial pacing was developed, but it has now come back, with a new methodology, in cardiological intensive care. Its safety and efficacy have been improved by 50 to 100 sq. cm electrodes, impulses of 20 to 40 ms duration and programmed energy. A perfect electrocardiographic analysis can be obtained by specific treatment of the pacing signal. New research work has begun concerning the sequence of activation. The hypothesis of simultaneous atrial and ventricular pacing, which has been put forward after the first experimental studies, is seldom confirmed by clinical data: it has been demonstrated that pacing is exclusively ventricular and that its influence on haemodynamics is equivalent to that of endocardial ventricular pacing. Transcutaneous pacing is the only technique that can be used in non-hospital extensive care, and this leads to the concept of mobile units performing defibrillation, ensuring electrophysiological monitoring and capable to treat circulatory arrests due to pause or ventricular tachyarrhythmias. Transcutaneous pacing is being reconsidered in cardiology units, where it can be used to reduce ventricular tachycardias, since it has the advantage over endocardial pacing or being immediately applicable and completely safe.
Trigano
J A
JA
Service de Cardiologie, Hôpital Nord, CHU, Marseille.
Birkui
P J
PJ
Degonde
J
J
D001145:Arrhythmias, Cardiac / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D008952:Mobile Health Units; D013909:Thorax
La stimulation cardiaque transcutanée thoracique.