External cardiac pacing in right ventricular infarction

A patient with acute inferior wall myocardial infarction presented with clinical evidence of right ventricular infarction complicated by bradycardia and cardiogenic shock. Pharmacologic interventions produced no change in heart rate or blood pressure, and a transvenous pacemaker failed to capture the infarcting right ventricle. An external transthoracic pacemaker immediately increased the heart rate with a marked hemodynamic improvement. In the setting of right ventricular infarction, external pacing may be more effective than transvenous pacing, perhaps due to its ability to pace the left ventricle.