Difference Between Demand vs. Non-Demand Pacing?

As you may recall from the online and in-class learning from Fall 2023 CME as well as the manufacturer guidelines for both LP15 and Zoll X Series regarding pacing:

Your monitor should default to demand pacing (used for most, if not all patients) which will allow it to disable the pacing function if the patient’s intrinsic rate or underlying rhythm beats above the set paced rate.

If the lead size is too small or your patient is too diaphoretic (leads don’t stick or come off) then the monitor will automatically switch to non-demand pacing mode or “fixed rate” meaning, the patient will be paced regardless of their intrinsic rate. This can also be selected manually if there is too much artifact interfering with sensing QRS complexes while transporting the patient. Remember, when pacing a patient you require both the leads (rhythm interpretation) and the pads (deliver electricity) to be in place.

Please note, you should make all attempts to clean, dry, shave the skin, select a different lead, increase lead size, and put on new leads prior to switching the monitor to non-demand pacing, as this comes with risks. For example, causing R-on-T phenomenon resulting in V-fib or V-tach as the monitor paces regardless of intrinsic electrical activity. If all troubleshooting techniques listed above have been attempted and you are still unable to pace the patient appropriately, you may switch modes without a patch and document the reasoning.

You can find this information by logging into MedicLEARN and searching 'symptomatic bradycardia' from Fall 2023 CME and by reading the manufacturer guidelines for your service's defibrillator.