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............................................................................................................................................................ stable as the transvenous approach, and is limited by the need for continuous sedation.783 This modality should only be used in emergency settings or when no other option is available, and under close haemodynamic monitoring.784 Before starting temporary pacing, chronotropic medication should be considered, taking into account side effects, contraindications, and interactions with other medication.

This Task Force concludes that temporary transvenous pacing should be avoided if possible; when it is required, the lead should remain in situ for as short a time as possible. The use of temporary pacing should be limited to the emergency treatment of patients with severe bradyarrhythmia causing syncope and/or haemodynamic compromise, and to cases in whom those bradyarrhythmias are anticipated. Temporary transvenous pacing is recommended when pacing indications are reversible, such as in the context of antiarrhythmic drug use, myocardial ischaemia, myocarditis, electrolyte disturbances, toxic exposure, after cardiac surgery, or as a bridge to permanent pacemaker implantation when this procedure is not immediately available or possible due to concomitant infection. Lastly, if a patient meets the permanent pacemaker implantation criteria, this procedure should be performed promptly. 11.4 Peri-operative management in

patients with cardiovascular implantable electronic devices Advisory documents to help manage patients with CIEDs in the perioperative period have been issued by several professional societies.786789 Supplementary Table 24 summarizes general recommendations on the management of these patients.

• Electromagnetic interference (EMI) may induce oversensing (more likely with unipolar leads), activation of rate-responsive sensors, device resetting, or other damage. The most common source of EMI is electrocautery, although it is rare during bipolar electrocautery >5 cm from the CIED and monopolar electrocautery below the umbilicus.790 To reduce the risk of EMI, monopolar electrocautery should be applied in short (<5 s) pulses, with the skin patches away from the area of the device. Other sources of EMI include radiofrequency procedures, nerve stimulators, and other electronic devices. • The peri-operative strategy should be tailored based on the individual needs and values of patients, procedure, and device.786789 Most procedures will not require any intervention.791 In pacemaker-dependent patients, a magnet should be applied during delivery of diathermy pulses, or, if EMI is likely to occur or magnet stability cannot be guaranteed, the device should be reprogrammed to an asynchronous mode (VOO/ DOO). The response to magnet application may differ between device manufactures. CIEDs with a rate-responsive function using an active sensor may also require magnet application or disabling of this function to prevent inappropriate rapid pacing. Post-operative CIED interrogation is recommended if malfunction is suspected or if the device has been exposed to strong EMI.

11.5 Cardiovascular implantable

electronic devices and sports activity Regular exercise is strongly recommended for prevention of cardiovascular disease.792795 Restrictions to patients with a pacemaker, where appropriate, are motivated by underlying cardiovascular disease. Therefore, it is important to address issues of exercise and sports participation with all pacemaker patients as part of a shared decision-making process. Comprehensive recommendations for physical activity in patients with cardiovascular disease have been published.792,796 There is consensus that contact sports (e.g. rugby or martial arts) should be avoided so as not to risk damage of device components or haematoma at the implantation site. For participation in sports such as football, basketball, or baseball, special protective shields are recommended to reduce the risk of trauma to the device. Sport interests and right or left arm dominance should be considered when selecting the implantation site, and submuscular placement can be considered to reduce the risk of impact. A lateral vascular access is

Recommendations regarding temporary cardiac pacing

Recommendations Classa Levelb

Temporary transvenous pacing is recommended in cases of haemodynamic-compromising bradyarrhythmia refractory to intravenous chronotropic drugs.764,765 I C Transcutaneous pacing should be considered in cases of haemodynamic-compromising bradyarrhythmia when temporary transvenous pacing is not possible or available.783785 IIa C Temporary transvenous pacing should be considered when immediate pacing is indicated and pacing indications are expected to be reversible, such as in the context of myocardial ischaemia, myocarditis, electrolyte disturbances, toxic exposure, or after cardiac surgery.771773 IIa C Temporary transvenous pacing should be considered as a bridge to permanent pacemaker implantation when this procedure is not immediately available or possible due to concomitant infection.771773 IIa C For long-term temporary transvenous pacing, an active fixation lead inserted through the skin and connected to an external pacemaker should be considered.641,776,777,779 IIa C

aClass of recommendation. bLevel of evidence. ESC 2021 Downloaded from academic.oup.com/eurheartj/article/42/35/3427/6358547 by guest on 07 October 2026