Pacing generally should be started in the synchronous mode. Madsen, however, echocardiographically demonstrated in humans that atrial stimulation was retrograde without opening the mitral valve. Studies have shown no difference in hemodynamics between transcutaneous and transvenous pacemakers, using comparable rates in complete heart block and cardiac arrest. Thus, external pacing must be used cautiously in patients with sinus bradycardia to ensure blood pressure is preserved. Placing electrodes over areas of least skeletal muscle can minimize discomfort.
Placement is generally best in the midline chest and just below the left scapula.
The physician also should use the lowest effective current. Sedation should be considered if these measures are inadequate. CPR CPR can be performed with the TEP pads in place. However, turning the unit off during CPR is advisable. In TEPs without an intrinsic defibrillator, separate leads need to be applied.