I read the article, “Mastering Temporary Invasive Cardiac Pacing” in the June issue of Critical Care Nurse (June 2004:25–32). It was very informative and well-written.

I was concerned by the following recommendation: The usual starting point is 10 mA in nonurgent situations. Output then is slowly increased until capture is obtained and the “pacing threshold” is defined. In emergent circumstances, starting with a high output (15–20 mA) is recommended. What happens if capture is obtained with 10 mA? How is the pacing threshold determined?

This appears to be a high level of energy. Generally, smaller levels of energy are required when directly pacing the endocardium or epicardium. Most temporary pacemaker generators (ie, Medtronic) have a maximum output of 20 to 25 mA.

To determine the pacing threshold once capture has occurred, the mA should be decreased until capture is...

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