Overview
The goal of this clinical trial is to learn if backup pacing at an increased rate improves hemodynamics in adults with relative bradycardia, a permanent pacemaker, and cardiogenic shock. The main question it aims to answer is:
Does increasing the backup pacing rate to 100 beats per minute lead to improved cardiac index compared to a backup pacing rate of 75 beats per minute
Participants who are already hospitalized in the Cardiovascular Intensive Care Unit with a permanent pacemaker and pulmonary artery catheter in place will be enrolled in this study. Participants will be exposed to each pacemaker rate in a randomized order with hemodynamics assessed after 10 minutes at each rate.
Eligibility
Inclusion Criteria:
- Adults (age 18 and older)
- Located in the CVICU
- FDA approved permanent pacemaker in place (inclusive of dual-chamber and Bi-Ventricular ICDs) with labeling that allows backup pacing setting at 100 bpm.
- Receiving a vasopressor or Inotrope for at least 4 hours
- Average HR ≤ 75 bpm over the last hour (on Telemetry review)
- Pulmonary artery catheter in place with functioning thermistor and pulmonary artery port.
Exclusion Criteria:
- Single chamber Implantable Cardiac Defibrillator
- Sinus rhythm with a leadless pacemaker
- Ventricular Tachycardia or Ventricular Fibrillation arrest in last 48 hours
- Hemodynamic instability within the last 4 hours, defined as an increase in the dose of norepinephrine > 10 mcg/min, an increase of epinephrine > 10 mcg/kg/min, or initiation of a second vasopressor
- Alternative indication for pacing rate change (i.e Torsade de Pointes, Recurrent Ventricular Tachycardia)
- Comfort-focused care or anticipated death within 24 hours
- Mechanical circulatory support in place
- Newly discovered pacing system malfunction (lead displacement, loss of capture, elevated capture threshold, significant lead impedance change, battery depletion, undersensing or oversensing)
- Non-English Speaking