A comprehensive course on cardiac surgery and critical care wouldn’t be complete without an understanding of cardiac electrophysiology in the perioperative setting—especially the use of temporary pacing and external pacemakers. While much attention is (rightfully) given to the plumbing of the heart—cannulas, grafts, and flow—the electrical system is just as vital to postoperative stability and survival. In fact, it's not uncommon for patients fresh off cardiopulmonary bypass to require some level of pacing support due to conduction abnormalities, nodal dysfunction, or surgical trauma to conduction tissue.

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Enter the world of temporary epicardial pacing wires, external pacemakers, and atrioventricular synchrony—tools and principles that can seem foreign to even seasoned ICU clinicians. The interface of wires, dials, thresholds, and modes (A, V, D, O?) can be bewildering at first glance. But don't worry—this section of "Master the Machines" will demystify the temporary pacemaker, break down pacing modes and troubleshooting strategies, and explain how and why pacing is used in the OR and CTICU. With input from surgical teams, electrophysiologists, and intensivists, we'll help you gain confidence in managing temporary pacing like a pro.