From the Guidelines
Atropine is the medication most commonly administered with transcutaneous pacing, at a dose of 0.5-1 mg IV, which may be repeated every 3-5 min to a maximum dose of 3 mg, as recommended by the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1.
Medication Administration
The administration of atropine with transcutaneous pacing is aimed at managing symptomatic sinus bradycardia or atrioventricular block.
- The dosage of atropine is crucial, and it is recommended to start with a dose of 0.5-1 mg IV.
- This dose may be repeated every 3-5 min to a maximum dose of 3 mg, as needed, to achieve the desired effect.
Rationale
The rationale for using atropine in this context is based on its pharmacological properties as an anticholinergic agent, which can help increase heart rate in patients with bradycardia.
- Atropine works by blocking the action of acetylcholine at the AV node, thereby increasing the heart rate.
- The use of atropine in transcutaneous pacing is supported by the 2018 ACC/AHA/HRS guideline, which provides evidence-based recommendations for the management of patients with bradycardia and cardiac conduction delay 1.
Clinical Considerations
In clinical practice, the administration of atropine with transcutaneous pacing should be carefully monitored, and the patient's vital signs, especially heart rate and blood pressure, should be closely watched.
- The dosage of atropine should be titrated to achieve the desired effect, and the patient's response to the medication should be continuously assessed.
- Other medications, such as dopamine, isoproterenol, and epinephrine, may also be considered in specific clinical scenarios, but atropine remains the first-line medication for transcutaneous pacing 1.
From the FDA Drug Label
Atropine Sulfate Injection, USP in clinical doses counteracts the peripheral dilatation and abrupt decrease in blood pressure produced by choline esters Atropine disappears rapidly from the blood following injection and is distributed throughout the body. The medication administered with transcutaneous pacing is atropine (IV), as it is used to counteract the effects of choline esters and has effects on the heart rate 2.
From the Research
Medication Administration with Transcutaneous Pacing
- There is no direct mention of a specific medication administered with transcutaneous pacing in the provided studies 3, 4, 5, 6, 7.
- However, it is mentioned that adequate sedation and analgesia are essential in ensuring patient comfort during transcutaneous pacing 5.
- The studies focus on the procedure, indications, and troubleshooting of transcutaneous pacing, but do not provide information on specific medications administered concurrently.
- One study mentions medication toxicity as a reversible cause of bradycardia, but does not specify the medication or its administration in relation to transcutaneous pacing 6.