Non-invasive Transthoracic Pacing

Non-invasive transthoracic pacing (NTP), an accepted emergency intervention since 1982, has been shown to be safe and effective over the ensuing years. It is considered to be a “tried and true” treatment modality, so little is written about it today. Even the American Heart Association (AHA) includes it as an integral step in the ACLS bradycardia algorithm.1 Most of the papers underlying the scientific basis for the practice of NTP were published in the 1980s and 1990s, with only a few advances coming to the forefront these last years.

What Is Non-invasive Transcutaneous Pacing?

NTP is the technique of electrically stimulating the heart by use of a set of pads placed externally on the torso. ECG electrodes are also placed on the patient to sense ventricular events (spontaneous or paced), and the pulse generator delivers a wave pulse when a predetermined escape interval has elapsed. The stimulus is intended to cause cardiac depolarization and subsequent myocardial contraction. NTP is a method to secure cardiac pacing quickly and effectively until a transvenous pacemaker can be inserted or the condition necessitating pacing resolves.