Transcutaneous overdrive pacing for refractory polymorphic ventricular tachycardia in the prehospital setting: A case report and practical considerations

Aim: To describe the use of transcutaneous overdrive pacing as a rescue intervention for refractory polymorphic ventricular tachycardia in the prehospital setting and highlight practical limitations in implementing guideline-recommended therapies in emergency medical services (EMS). Materials and methods: We present a case of recurrent polymorphic ventricular tachycardia following out-of-hospital cardiac arrest, focusing on therapeutic decision-making, implementation of transcutaneous overdrive pacing, and differences between guideline recommendations and therapies immediately available in the prehospital environment. Conclusions: This case illustrates the gap between guideline recommendations and real-world prehospital capabilities. When conventional therapies have been exhausted and transvenous pacing is unavailable, transcutaneous overdrive pacing may represent a feasible rescue strategy. Emergency clinicians should recognize situations in which this intervention may be considered and understand the practical differences between transvenous and transcutaneous pacing.