La estimulación cardiaca temporal transvenosa es la modalidad de elección cuando se precisa estimulación cardiaca temporal continua, ya como puente a la resolución de la bradiarritmia o al implante del marcapasos definitivo. Generalmente es suficiente estimular el ventrículo derecho, salvo en situaciones hemodinámicas muy especiales como son el shock en el infarto de ventrículo derecho o la miocardiopatía hipertrófica obstructiva con bloqueo auriculoventricular.
La estimulación cardiaca transcutánea es la más adecuada para solventar las situaciones de emergencia que requieren un soporte de estimulación cardiaca y en la mayoría de las profilácticas, con lo que en estas últimas se evita las potenciales complicaciones de la endovenosa.
La estimulación epicárdica temporal tras la cirugía cardiaca, además de la contribución al tratamiento de las frecuentes alteraciones posquirúrgicas de la conducción, tiene un importante papel en la contribución al gasto cardiaco dependiente de la frecuencia y en la reducción o prevención de la fibrilación auricular postoperatoria. En los pacientes con disfunción ventricular izquierda y complejo QRS ancho preoperatorio, es deseable dejar implantados unos electrodos temporales en el ventrículo izquierdo, para poder realizar estimulación biventricular si fuese necesario. La decisión del momento más adecuado para la implantación de un marcapasos definitivo tras cirugía cardiaca es materia de controversia y debería ser individualizado para cada paciente.
Palabras clave
Marcapasos temporal
Estimulación transcutánea
Estimulación tras cirugía cardiaca
Estimulación epicárdica
Bloqueo auriculoventricular
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