Pacer pads and automated implantable cardioverter defibrillator in intubated patient


Pacer pads are devices used for transcutaneous pacemakers, which regulate heart rate to maintain cardiac output via electricity externally applied above the skin. These devices are the fastest method to treat bradyarrhythmias, which is their major indication 1. Transcutaneous pacing is a temporary method that is applied until a permanent pacemaker can be placed or when a permanent pacemaker is contraindicated. Pacer pads are usually positioned with a negatively-charged pad at the apex of the heart and a positively-charged pad in the parasternal or subscapular region.

In this patient, a negative pad was placed at the apex and a positive pad was placed in the parasternal region, as seen in the diagram above. Transcutaneous pacemakers are contraindicated in hemodynamically stable patients, as they can reduce stroke volume significantly 2. Studies suggest that transcutaneous pacemaking have similar hemodynamic benefits as internal right ventricular pacing but improvement to patient outcomes has so far been inconclusive 3

This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.