Augmented Pacing for Shock in the Cardiac Intensive Care Unit

Inclusion Criteria: * Adults (age 18 and older) * Located in the CVICU * FDA approved permanent pacemaker in place (inclusive of dual-chamber and Bi-Ventricular ICDs) with labeling that allows backup pacing setting at 100 bpm. * Receiving a vasopressor or Inotrope for at least 4 hours * Average HR ≤ 75 bpm over the last hour (on Telemetry review) * Pulmonary artery catheter in place with functioning thermistor and pulmonary artery port. Exclusion Criteria: * Single chamber Implantable Cardiac Defibrillator * Sinus rhythm with a leadless pacemaker * Ventricular Tachycardia or Ventricular Fibrillation arrest in last 48 hours * Hemodynamic instability within the last 4 hours, defined as an increase in the dose of norepinephrine \> 10 mcg/min, an increase of epinephrine \> 10 mcg/kg/min, or initiation of a second vasopressor * Alternative indication for pacing rate change (i.e Torsade de Pointes, Recurrent Ventricular Tachycardia) * Comfort-focused care or anticipated death within 24 hours * Mechanical circulatory support in place * Newly discovered pacing system malfunction (lead displacement, loss of capture, elevated capture threshold, significant lead impedance change, battery depletion, undersensing or oversensing) * Non-English Speaking