Cardiac Pacing in Adults

  • Daniel Keene
  • S. M. Afzal Sohaib
  • Tom Wong


The heart is served by intrinsic, efficient and coordinated electrical activation provided by its specialised conduction system. The conduction system can be damaged, requiring the provision of pacing to maintain an adequate cardiac output. Causes of cardiac conduction disease are most commonly idiopathic or degenerative relating to calcium deposition. Pacing is not uncommonly indicated after cardiac surgery, particularly following procedures on the aortic valve especially in the presence of underlying conduction disease. The disturbance and damage caused to the conduction system may be short lived and resolve whilst back-up pacing support is provided by a temporary pacing system or more permanent damage may result requiring a permanent pacing solution. Managing a temporary pacing system and determining if and when to convert to a permanent pacing approach can at times be difficult. This chapter provides an overview of standard indications for pacemakers and implantable defibrillators as well as clarifies basic principles of pacing including commonly used terms such as threshold and sensitivity. It explores new developments in the sphere of cardiac pacing such as pacemakers in an MRI field as well as emerging technologies namely leadless and His bundle pacing. It includes a practical section on troubleshooting of temporary epicardial systems and provides insight into cases where cardiac surgeons may be called upon to assist cardiology colleagues, namely, surgical lead implantation or lead extraction.


Cardiac pacing Defibrillator Heart block Implantable cardioverter defibrillator Pacemaker 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Daniel Keene
    • 1
  • S. M. Afzal Sohaib
    • 2
  • Tom Wong
    • 3
    • 4
  1. 1.Imperial CollegeLondonUK
  2. 2.The Barts Heart Centre, Barking, Havering and Redbridge HospitalsSt Bartholomew’s HospitalLondonUK
  3. 3.Royal Brompton and Harefield NHS Foundation TrustHarefieldUK
  4. 4.National Heart and Lung InstituteImperial CollegeLondonUK

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