The use of temporary cardiac pacing in critical care and stepdown units has grown tremendously over the past 10 years. While the concept of artificial pacing is simple, improvements in generator technology and lead design, along with broader clinical applications, have made temporary cardiac pacing more complex. Consequently, the critical care nurse is required to maintain an advanced level of knowledge regarding modes and complications of temporary pacing, and assessment skills related to recognizing pacemaker hemodynamic effects and pacemaker problems