Pacemakers

[cvnurse1]

When weaning an epicardial pacer and looking at intrinsic rate. Do you turn the rate down to look at intrinsic or just pause. Reason i ask bc cv surgeon told us not to pause pacer bc it can make pt asystole and lose the pt but instead to turn to rate down to 40 and if theres no intrinsic rate greater than then to turn back up to 80-90 and reassess later.

[limaRN, BSN, RN]

I turn the rate down gradually for that reason (that if there is no underlying rhythm the pt could be asystolic). So I agree with the surgeon.

[andi.w]

On my unit we have always just completely paused the pacer, and it always makes me so nervous! I agree that it should be turned down gradually. I feel like it's a nursing judgement call, and if the physician wants to completely pause it, then he should be immediately available.

[Nursingbride12]

When weaning an epicardial pacer and looking at intrinsic rate. Do you turn the rate down to look at intrinsic or just pause. Reason i ask bc cv surgeon told us not to pause pacer bc it can make pt asystole and lose the pt but instead to turn to rate down to 40 and if theres no intrinsic rate greater than then to turn back up to 80-90 and reassess later.

I work on a Cardiac Transplant/ Cardiac Surgery unit and we have pacemakers come back from the OR all the time. What our surgeons say is that if you completely pause the pacemaker, it is almost a shock to the heart and doesn't allow the heart to will itself back to it's intrinsic rate. So when you pause the pacemaker all together, the heart will 90% of the time have either a junctional rate or asystole. According to them, this is the best way to assess for an intrinsic rhythm.