In symptomatic bradycardia, external pacing is indicated. What rate should be set at?

• A. 60 bpm
• B. 70 bpm
• C. 90 bpm
• D. 50 bpm

Answer: (B)

In symptomatic bradycardia, the goal of external pacing is to raise the heart rate enough to improve perfusion without causing undue stress on the heart. Setting the pacer to about 70 beats per minute provides a safe, effective rate for adults: it’s fast enough to enhance cardiac output and tissue perfusion, yet not so fast that it increases myocardial oxygen demand or reduces diastolic filling time too much.

Choosing a lower rate, like 60 or 50, may not sufficiently improve perfusion and symptoms can persist. A higher rate, such as 90, risks tachycardia and its own complications. If the patient remains unstable after pacing at around 70, you would reassess and adjust as needed, ensuring electrical capture and considering escalation to transvenous pacing if necessary.