[Perioperative temporary pacemaker therapy].

INTRODUCTION: Numerous factor can precipitate progression of incomplete heart block to complete heart block in the perioperative period. While there is a consensus of the indications of acute temporary pacing, there is no widely accepted guidelines for the elective perioperative temporary pacing. The indications are clear in the cases of second or third degree atrio-ventricular block, bradycardias, bradyarrhythmias with frequency less than 50/min not responding to atropine, but there are many debate in the cases of first degree atrio-ventricular block with bifascicular or left bundle branch block. Furthermore, during the operation bradyarrhythmia, complete atrio-ventricular block not responding to atropine can develop without any sign on the previous ECG at rest.

METHODS AND RESULTS: The authors review the different methods of pacing (transvenous, transcutaneous, transoesophageal), summarize the advantages and disadvantages of each method, the complications and their prevention. Patients' condition, concomitant medical treatment, designed procedures and staffs' experience in the introduction of pacemaker electrode must be considered in questioned cases.

CONCLUSIONS: The transcutaneous method is easily performed, don't need a lot of experience. It must be available in every operating theatre and in the questioned cases may be enough until the introduction of the transvenous electrode, if the field of operation make the electrode placement possible.