- Overdrive pacing = pacing the heart at a higher rate than the native heart rate
- VT or VF can result -> always have DC cardioversion available
- 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
- 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
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.