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Challenges in Clinical Electrocardiography
September 8, 2020

Troubleshooting a Transcutaneous Pacemaker

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
  • 3Section Editor, JAMA Internal Medicine
JAMA Intern Med. Published online September 8, 2020. doi:10.1001/jamainternmed.2020.3828

A woman in her 80s presented to the emergency department with altered mental status, weakness, slurred speech, emesis, and headache. Emergency medical services found her pulse rate in the 20s, so transcutaneous pacing was initiated. Her initial vital signs in the emergency department were blood pressure of 100/73 mm Hg, heart rate of 49 beats/min, respiratory rate of 27 breaths/min, and oxygen saturation of 95% on a nonrebreather mask. Computed tomography of the head showed no acute pathology, and chest radiography showed a pulmonary consolidation. She was intubated for airway protection. An electrocardiogram (ECG) obtained subsequently, after her transient bradycardia had resolved, is shown in the Figure.