Overdrive Pacing

OVERVIEW

• Overdrive pacing = pacing the heart at a higher rate than the native heart rate
• VT or VF can result -> always have DC cardioversion available

INDICATIONS

• failure of drug therapy
• recurrent arrhythmia
• contraindication to cardioversion (digoxin toxicity)
• aid to differentiate VT from SVT

RHYTHMS THAT CAN BE CONTROLLED

• AV junctional tachycardia
• paroxysmal re-entrant SVT
• atrial flutter (rate 320-340)
• SVT with rapid ventricular response that fails to revert
• VT (may precipitate VF)

RHYTHMS THAT CAN’T BE CONTROLLED

• AF
• VF
• sinus tachycardia

OVERDRIVE PACING VS CARDIOVERSION

• may assist with rhythm diagnosis
• can use in digoxin toxicity
• doesn’t require GA
• avoids complications of DC shock (myocardial depression)
• pacing available post electrical version (in case of bradycardia or asystole)

OVERDRIVE PACING VS DRUGS

• may aid in rhythm diagnosis
• avoid drug induced cardiac depression and other side effects
• can be used when drug therapy fails
• termination of the tachycardia with pacing often immediate
• standby pacing immediately available