cardiac pacemakers new

7/17/2019 Cardiac Pacemakers new

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Cardiac Assist Devices


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Types

Pacemakers

AICDs

VADs


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History

First pacemaker implanted in 1958

First ICD implanted in 1980

Greater than 500000 patients in the !"p#p$lati#n have pacemakers

115000 implanted each year


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Pacemakers Today "in%le #r d$al cham&er

'$ltiple pr#%ramma&le (eat$res

Adaptive rate pacin% Pr#%ramma&le lead c#n(i%$rati#n


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Internal Cardiac

Defbrillators (ICD) Transven#$s leads '$ltipr#%ramma&le

Inc#rp#rate all capa&ilities #(c#ntemp#rary pacemakers

"t#ra%e capacity


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Temporary Pacing

Indications )#$tes * Transven#$s transc$tane#$ses#pha%eal

!nsta&le &radydysrhythmias Atri#ventric$lar heart &l#ck

!nsta&le tachydysrhythmias

+,ndp#int reached a(ter res#l$ti#n #( the

pr#&lem #r permanent pacemaker implantati#n


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Permanent Pacing

Indications Chr#nic AV-. Chr#nic .i(ascic$lar and Tri(ascic$lar .l#ck

AV-. a(ter Ac$te 'I

"in$s /#de Dys($ncti#n -ypersensitive Car#tid "in$s and /e$rally

'ediated "yndr#mes

'iscellane#$s Pacin% Indicati#ns


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Chronic AVHB ,specially i( sympt#matic

Pacemaker m#st c#mm#nly indicated (#r

Type 2

.l#ck #cc$rs 3ithin #r &el#3 the .$ndle #( -is

42 -eart .l#ck /# c#mm$nicati#n &et3een atria and ventricles


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Chronic Biascic!lar andTriascic!lar Block

Di((erentiati#n &et3een $ni &i and

tri(ascic$lar &l#ck

"ync#pe c#mm#n in patients 3ith

&i(ascic$lar &l#ck

Intermittent 42 heart &l#ck c#mm#n


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AVHB ater Ac!te "I Incidence #( hi%h %rade AV-. hi%her Indicati#ns (#r pacemaker related t#

intraventric$lar c#nd$cti#n de(ects rather

than sympt#ms Pr#%n#sis related t# etent #( heart

dama%e


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#in!s $ode Dys!nction "in$s &radycardia sin$s pa$se #r arrest #r

sin#atrial &l#ck chr#n#tr#pic inc#mpetence 6(ten ass#ciated 3ith par#ysmal "VTs

7&radycardiatachycardia syndr#me 'ay res$lt (r#m dr$% therapy "ympt#matic: 6(ten the primary indicati#n (#r a pacemaker


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Hypersensiti%e Carotid#in!s #yndrome

; "ync#pe #r presync#pe d$e t# an

ea%%erated resp#nse t# car#tid sin$s

stim$lati#n

; De(ined as asyst#le %reater than 4 sec d$e

t# sin$s arrest #r AV-. an a&r$pt

red$cti#n #( .P #r th


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$e!rally "ediated#yncope

10


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"iscellaneo!s -ypertr#phic 6&str$ctive Cardi#my#pathy Dilated cardi#my#pathy Cardiac transplantati#n Terminati#n and preventi#n #(

tachydysrhythmias Pacin% in children and ad#lescents


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Indications or ICDs Cardiac arrest d$e t# VT>VF n#t d$e t# a

transient #r reversi&le ca$se "p#ntane#$s s$stained VT

"ync#pe 3ith hem#dynamically si%ni(icants$stained VT #r VF /"VT 3ith CAD previ#$s 'I ?V dys($ncti#n and

ind$ci&le VF #r VT n#t s$ppressed &y a class 1antidysrhythmic


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De%ice #election Temp#rary pacin% 7invasive vs@

n#ninvasive

Permanent pacemaker

ICD


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Pacemaker Characteristics

; Adaptiverate pacemakers

;"in%lepass lead "ystems

; Pr#%ramma&le lead c#n(i%$rati#n

; A$t#matic '#de"3itchin%

; !nip#lar vs@ .ip#lar electr#de

c#n(i%$rati#n


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ICD selection Anti&radycardia pacin%

Antitachycardia pacin%

"ynchr#nied #r n#nsynchr#nied sh#cks

(#r dysrhythmias

'any #( the #ther #pti#ns inc#rp#rated

int# pacemakers


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Appr#aches t# Inserti#n

a@ IV appr#ach 7end#cardial lead

&@ "$&c#stal appr#ach 7epicardial #r

my#cardial lead

c@ /#ninvasive transc$tane#$s pacin%

Alternative t# emer%ency transven#$s pacin%


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'echanics

Pr#vide the rhythm heart cann#t pr#d$ce

,ither temp#rary #r permanent

C#nsists #( eternal #r internal p#3er

s#$rce and a lead t# carry the c$rrent t#

the heart m$scle

.atteries pr#vide the p#3er s#$rce

Pacin% lead is a c#iled 3ire sprin% encased insilic#ne t# ins$late it (r#m dy (l$ids


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!nip#lar Pacemaker

?ead has #nly #ne electr#de that c#ntactsthe heart at its tip 7B p#le

The p#3er s#$rce is the 7 p#le

Patient serves as the %r#$ndin% s#$rcePatients dy (l$ids pr#vide the ret$rn

path3ay (#r the electrical si%nal

,lectr#ma%netic inter(erence #cc$rs m#re#(ten in $nip#lar leads


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!nip#lar Pacemaker


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.ip#lar Pacemaker

I( &ip#lar there are t3# 3ires t# the heart #r

#ne 3ire 3ith t3# electr#des at its tip

Pr#vides a &$iltin %r#$nd lead

Circ$it is c#mpleted 3ithin the heart

Pr#vides m#re c#ntact 3ith the

end#cardi$m needs l#3er c$rrent t#

pace

?ess chance (#r ca$tery inter(erence


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.ip#lar Pacemaker


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Indicati#ns

1@ "ick sin$s syndr#me 7Tachy&radysyndr#me

@ "ympt#matic &radycardia

4@ Atrial (i&rillati#n


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Indications

E@ C#mplete heart &l#ck

@ "in$s arrest>&l#ck

8@ Tachyarrhythmias

"$praventric$lar ventric$lar

T# #verdrive the arrhythmia


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Atrial Fi&rillati#n

+ A (i&rillatin% atri$m cann#t &e paced

+ Place a VVI

+ Patient has n# atrial kick


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Types

1@ Asynchr#n#$s>Fied )ate

@ "ynchr#n#$s>Demand

4@ "in%le>D$al Cham&er"e$ential 7A H V

n#npr#%ramma&le


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Asynchr#n#$s>Fied )ate

D#es n#t synchr#nie 3ith intrinsic -)

!sed sa(ely in pts 3ith n# intrinsic

ventric$lar activity

I( pt has vent@ activity it may c#mpete

3ith pts #3n c#nd$cti#n system

VT may res$lt 7)#nT phen#men#n

, V66 A66 D66


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"ynchr#n#$s>Demand

C#ntains t3# circ$its + 6ne (#rms imp$lses

+ 6ne acts as a sens#r

Jhen activated &y an ) 3ave sensin% circ$iteither tri%%ers #r inhi&its the pacin%circ$it

Called KTri%%eredL #r KInhi&itedL pacers

'#st (re$ently $sed pacer

,liminates c#mpetiti#n

,ner%y sparin%


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,amples #( Demand Pacemakers

DDI

VVI>VVT

AAI>AAT

Disadvanta%e Pacemaker may &e (##led &y

inter(erence and may n#t (ire


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D$al Cham&er AV

"e$ential

Facilitates a n#rmal se$ence &et3een

atrial and ventric$lar c#ntracti#n

Pr#vides atrial kick B ventric$lar pacin%Atrial c#ntracti#n ass$res m#re c#mplete

ventric$lar (illin% than the ventric$lar

demand pacin% $nit

Increase C6 545= #ver ventric$lar pacin%

al#ne


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AV "e$ential

Disadvanta%e '#re di((ic$lt t# place

'#re epensive

C#ntraindicati#n Atrial (i&rillati#n "VT

Devel#ped d$e t# inade$acy #( Kp$re atrial

pacin%L


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"in%le Cham&er

Atrial

Ventric$lar


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KP$re Atrial Pacin%L

!sed 3hen "A n#de is diseased #rdama%ed &$t AV c#nd$cti#n system

remains intact

Pr#vides atrial kick

Atrial kick can add 1540= t# C6 #ver a

ventric$lar pacemaker

,lectr#de in atri$m stim$l$s pr#d$ces a

P 3ave


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Pr#&lems 3ith Atrial Pacin%

,lectr#de di((ic$lt t# sec$re in atri$m

Tends t# (l#at

Ina&ility t# achieve c#nsistent atrial

KdemandL ($ncti#n


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Ventric$lar Pacemakers

I( electr#de is placed in ri%ht ventricle

stim$l$s pr#d$ces a le(t ... pattern

I( electr#de is placed in le(t ventricle

stim$l$s pr#d$ces a ri%ht ... pattern


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Pr#%ramma&ility

Capacity t# n#ninvasively alter #ne #( severalaspects #( the ($ncti#n #( a pacer

Desira&le since pacer re$irements (#r a pers#n

chan%e #ver time

'#st c#mm#n pr#%rammed areas)ate

6$tp$t

AV delay in d$al cham&er pacers

) 3ave sensitivity

Advanta%e can #verc#me inter(erence

ca$sed &y electr#ca$tery


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4?etter #r 5?etter C#de

Devised t# simpli(y the namin% #(

pacemaker %enerat#rs


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First letter

Indicates the cham&er &ein% paced

A Atri$m

V Ventricle

D D$al 7.#th A and V

6 /#ne


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"ec#nd ?etter

Indicates the cham&er &ein% sensed

A Atri$m

V Ventricle

D D$al 7.#th A and V

6 Asynchr#n#$s #r d#es n#t apply


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Third ?etter

Indicates the %enerat#rs resp#nse t# a

sensed si%nal>) 3ave

I Inhi&ited

T Tri%%ered

D D$al 7T H I

6 Asynchr#n#$s> d#es n#t apply


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F#$rth ?etter

Indicates pr#%rammin% in(#rmati#n

6 /# pr#%rammin%

P Pr#%rammin% #nly (#r #$tp$t and>#r rate

' '$ltipr#%ramma&le

C C#mm$nicatin%

) )ate m#d$lati#n


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Fi(th ?etter

This letter indicates tachyarrhythmia

($ncti#ns

. .$rsts

/ /#rmal rate c#mpetiti#n

" "cannin%

, ,ternal

6 /#ne

Ta&le #( Pacer C#des


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Ta&le #( Pacer C#des

ypes # $ se enera #rs


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ypes # $ se enera #rs


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,amples

A66

A Atri$m is paced

6 /# cham&er is sensed

6 Asynchr#n#$s>d#es n#t applyV66

V Ventricle is paced

6 /# cham&er is sensed6 Asynchr#n#$s>d#es n#t apply


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,amples

VVI

V Ventricle is the paced cham&er

V Ventricle is the sensed cham&er

I Inhi&ited resp#nse t# a sensed

si%nal

Th$s a synchr#n#$s %enerat#r that paces

and senses in the ventricle

Inhi&ited i( a sin$s #r escape &eat #cc$rs

Called a KdemandL pacer


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,amples

DVI

D .#th atri$m and ventricle are

paced

V Ventricle is sensed

I )esp#nse is inhi&ited t# a sensed

ventric$lar si%nal

F#r AV se$ential pacin% in 3hich atria and

ventricles are paced@ I( a ventric$larsi%nal %enerat#r 3#nt (ire

6verridden &y intrinsic -) i( (aster

, l


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,amples

DDD

Greatest (lei&ility in pr#%rammin%.est appr#imates n#rmal cardiac resp#nse t# eercise

D66

'#st apparent p#tential (#r seri#$s ventric$lar

arrhythmias

VAT

Ventric$lar paced atrial sensed

"h#$ld have an atrial re(ract#ry peri#d pr#%rammed in

t# prevent risk #( arrhythmias ind$ced &y PACs(r#m ect#pic #r retr#%rade c#nd$cti#n

AV interval is $s$ally 15050 millisec#nds


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6ther In(#rmati#n

Demand pacer can &e m#mentarily c#nverted t#

asynchr#n#$s m#de &y placin% ma%net eternally

#ver p$lse %enerat#r in s#me pacers

D$al cham&er pacers pre(era&le (#r alm#st allpatients ecept th#se 3ith chr#nic atrial

(i&rillati#n 7need a 3#rkin% c#nd$cti#n system

Asynchr#n#$s pacer m#des n#t %enerally $sed

#$tside the 6)6) has m$ltiple p#tential s#$rces #( electrical inter(erence

3hich may prevent n#rmal ($ncti#n #( demand pacers


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6ther In(#rmati#n

VVI "tandard ventric$lar demandpacemaker

DVI AV pacemaker 3ith t3# pacin%

electr#desDemand pacer may &e #verridden &y

intrinsic -) i( m#re rapid

Demand pacer can &e m#mentarilyc#nverted t# asynchr#n#$s m#de &yplacin% ma%net eternally #ver p$lse%enerat#r


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"ensin%

A&ility #( device t# detect intrinsic cardiac

activity

!ndersensin% (ail$re t# sense

6versensin% t## sensitive t# activity


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!ndersensin% Fail$re t# sense

Pacer (ails t# detect an intrinsic rhythm

Paces $nnecessarily

Patient may (eel Ketra &eatsL

I( an $nneeded pacer spike (alls in the latter

p#rti#n #( T 3ave dan%er#$s

tachyarrhythmias #r V (i& may #cc$r 7)

#n TT Increase sensitivity #( pacer


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6versensin%

Pacer interprets n#ncardiac electricalsi%nals as #ri%inatin% in the heart

Detects etrane#$s si%nals s$ch as th#se

pr#d$ced &y electrical e$ipment #r theactivity #( skeletal m$scles 7tensin%(lein% #( chest m$scles "!

Inhi&its itsel( (r#m pacin% as it 3#$ld a tr$e

heart &eat


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6versensin%

6n ,CG pa$ses l#n%er than the n#rmal

pacin% interval are present

6(ten electrical arti(act is seenDeprived #( pacin% the patient s$((ers

C6 (eels diy>li%htheaded

'#st #(ten d$e t# sensitivity &ein%pr#%rammed t## hi%h

T )ed$ce sensitivity


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Capt$re

Dep#lariati#n #( atria and>#r ventricles in

resp#nse t# a pacin% stim$l$s


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/#ncapt$re>Fail$re t# Capt$re

Pacers electrical stim$l$s 7pacin% (ails t#dep#larie 7capt$re the heart

There is n# K(ail$re t# paceL

Pacin% is simply $ns$ccess($l at stim$latin% ac#ntracti#n

,CG sh#3s pacer spikes &$t n# cardiacresp#nse

C6 #cc$rs

T thresh#ld>#$tp$t stren%th #r d$rati#n


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Pacer Fail$re

A@ ,arly

electr#de displacement>&reaka%e

.@ Fail$re M E m#nths

Premat$re &attery depleti#n

Fa$lty p$lse %enerat#r

P ' l( ti ,CG


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Pacer 'al($ncti#ns per ,CG

Fail$re t# capt$re

Fail$re t# sense

)$na3ay pacemaker


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Pacer 'al($ncti#n "

1@ Verti%#>"ync#pe

+J#rsens 3ith eercise

@ !n$s$al (ati%$e

4@ ?#3 .>P> peripheral p$lses6rth#pnea

8@ Altered mental stat$s


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,OG ,val$ati#n

Capt$re "h#$ld &e 11

7spike,OG c#mple>p$lse

+/#t help($l i( patients -) is M

pacer rate i( synchr#n#$s type


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,OG ,val$ati#n

Pr#per ($ncti#n #( demand pacer

C#n(irmed &y seein% capt$red &eats #n ,OG

3hen pacer is c#nverted t# asynchr#n#$s

m#dePlace eternal c#nverter ma%net #ver %enerat#r

D# n#t $se ma%net $nless rec#mmended


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CAPT!),

6$tp$t amt #( c$rrent 7mAmps needed t#

%et an imp$lse

"ensitivity 7milliv#lts the l#3er the

settin% the m#re sensitive


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Anesthesia (#r Inserti#n'AC

T# pr#vide c#m(#rt

T# c#ntr#l dysrhythmias

T# check (#r pr#per ($ncti#n>capt$re

-ave eternal pacer>Is$prel>Atr#pineready

C#ntin$#$s ,CG and peripheral p$lse

P$lse # 3ith plethysm#%raphy t# seeper($si#n #( each c#mple

7,OG may &ec#me $nreada&le

Pacemaker Inserti#n


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Pacemaker Inserti#n


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Inter(erence

Thin%s 3hich may m#di(y pacer ($ncti#n

"ympath#mimetic amines may increasemy#cardial irrita&ility

$inidine>Pr#cainamide t#icity may ca$se(ail$re #( cardiac capt$re

OB advanced ht disease #r (i&r#sis ar#$ndelectr#de may ca$se (ail$re #( cardiaccapt$re

A th i ( Pt ith


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Anesthesia (#r Pt 3ith

Pacemakera@ C#ntin$#$s ,CG and peripheral p$lse

&@ P$lse # 3ith plethysm#%raphy t#

see per($si#n #( each c#mple

7,OG may &ec#me $nreada&le

c@ De(i&rillat#r>crash cart availa&le

d@ ,ternal pacer availa&le

e@ ,ternal c#nverter ma%net availa&le

Anesthesia (#r Pt 3ith Pacemaker


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I( $sin% "$ccinylch#line c#nsider de(ascic$latin% d#se#( ')

Fascic$lati#ns may inhi&it (irin% d$e t# the skeletalm$scle c#ntracti#ns picked $p &y %enerat#r asintrinsic ) 3aves

Place %r#$nd pad (ar (r#m %enerat#r &$t cl#se t#ca$tery tip

C#ver pad 3ell 3ith c#nd$ctive %el

'inimies detecti#n #( ca$tery c$rrent &y p$lse

%enerat#rI( patient has a transven#$s pacemaker increased risk

#( V@ (i& (r#m micr#sh#ck levels #( electricalc$rrent

A th i ( Pt ith P k


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Ca$tery may inter(ere 3ith pacer

'ay inhi&it tri%%erin% 7pacer may sense

electrical activity and n#t (ire

'ay inadvertently repr#%ram'ay ind$ce arrhythmias sec#ndary t# c$rrent

'ay ca$se (iedrate pacin%


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A$t#matic

Implanta&le

Cardiac

De(i&rillat#rs


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AICD


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Parts #( AICD

P$lse %enerat#r 3ith &atteries

and capacit#rs

,lectr#de #r lead system

"$r%ically placed in #r #n

pericardi$m>my#cardi$m

'#nit#rs -) and rhythm

Delivers sh#ck i( VT #r V(i&


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Placement #( AICD

Pulse Generator


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AICD Indicati#ns

)isk (#r s$dden cardiac death

ca$sed &y tachyarrhythmias 7VT V(i&

)ed$ces death (r#m


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De(i&rillat#r C#des

First letter "h#ck Cham&er

A atri$m

V ventricle

D d$al6 n#ne


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De(i&rillat#r C#des

"ec#nd letter Antitachycardia Cham&er

A atri$m

V ventricle

D d$al6 n#ne

Third letter Tachycardia Detecti#n

, ,OG- -em#dynamics

Defbrillator Codes


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Defbrillator Codes

F#$rth letter Anti&radycardia Pacin%

Cham&er

A atri$m

V ventricleD d$al

6 n#ne


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"ettin%s

Gives a sh#ck at 0@140 Q#$les

!s$ally 5 Q#$les

Takes 50 sec#nds t# sense VT>VF

Takes 515 sec#nds m#re t# char%e@510 sec#nd delay &e(#re net sh#ck is

administered

T#tal #( 5 sh#cks then pa$ses

I( patient is t#$ched may (eel a &$ #r tin%leI( CP) is needed 3ear r$&&er %l#ves (#r

ins$lati#n


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Tiered Therapy

A&ility #( an implanted cardi#verter

de(i&rillat#r t# deliver di((erent types #(

therapies in an attempt t# terminateventric$lar tachyarrhythmias

, #( therapies

Anticardiac pacin%

Cardi#versi#nDe(i&rillati#n

Anti&radycardia pacin%


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Anesthesia

'AC vs General

!s$ally %eneral d$e t# ind$cti#n #( VT>VF s#

AICD can &e checked (#r per(#rmance

?ead is placed in heartGenerat#r is placed in hip area #r in $pper

chest


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VADs

Ventric$lar assist devices

Implanta&le p$mps $sed (#r circ$lat#rys$pp#rt in pts 3ith C-F

.l##d (ills device thr#$%h a cann$lati#n sitein V #r A

Diaphra%m p$mps &l##d int# a#rta #r PA

"et at predetermined rate 7(ied #ra$t#matic 7rate chan%es in resp#nse t#ven#$s ret$rn

,lectr#ma%netic Inter(erence


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#n Pacers and AICDs

,lectr#ca$tery

'ay inhi&it #r tri%%er #$tp$t'ay revert it t# asynchr#n#$s m#de

'ay repr#%ram inappr#priately

'ay ind$ce A(i& #r V(i&'ay &$rn at leadtiss$e inter(ace

,lectr#ma%netic Inter(erence #n


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,lectr#ma%netic Inter(erence #n

Pacers and AICDs

De(i&rillati#n

'ay ca$se permanent dama%e t# p$lse

%enerat#r

'ay &$rn at leadtiss$e inter(ace)adiati#n Therapy

'ay dama%e metal #ide silic#n circ$itry




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#n Pacers and AICDs

P,T>CT 7C#ntraindicated'ay dama%e metal #ide silic#n circ$itry


')I 7C#ntraindicated'ay physically m#ve p$lse %enerat#r'ay repr#%ram inappr#priately

'ay %ive inappr#priate sh#ck t# pt 3ith AICD

P/"s'ay ca$se inappr#priate sh#ck #r inhi&iti#n

Test at hi%hest #$tp$t settin%

Deactivatin% a Pacemaker


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Deactivatin% a Pacemaker

Deactivate t# prevent inappr#priate (irin% #rinhi&iti#n

Can &e deactivated &y a special

pr#%rammer>3and #r &y a ma%net placed

#ver %enerat#r (#r 40 sec#nds

P$t in asynchr#n#$s m#de #r place eternal

pacer #n patient


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I( Pt has a Pacemaker>AICD

/#t all m#dels (r#m a certain c#mpany&ehave the same 3ay 3ith ma%net

placement R

For all generators, call manufacturerMost reliable method for determining magnet

response ! !

C#din% Patient


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C#din% Patient

I( patient c#des d# n#t 3ait (#r AICDt# 3#rk

"tart CP) H de(i&rillate immediately

Pers#n %ivin% CP) may (eel sli%ht &$A 40Q#$le sh#ck is S Q #n pts skin

,ternal de(i&rillati#n 3ill n#t harm AICD

Chan%e paddle placement i( $ns$ccess($lattempt

Try AP paddle placement i( A?at$ns$ccess($l

Pts 3ith


89/108

89

Pacemakers>AICDs>VADs

6&tain in(#rmati#n (r#m patient re%ardin%device

Ask h#3 #(ten patient is sh#cked>day

-i%h #r l#3 OB may render end#thelial cellsm#re #r less re(ract#ry t# pacin%

A pr#perly capt$rin% pacemaker sh#$ld als#

&e c#n(irmed &y 3atchin% the ,OG andpalpatin% the patients p$lse

Anesthetic C#nsiderati#ns


90/108

90

Anesthetic C#nsiderati#ns

Av#id "$ccinylch#line

Oeep P/" as (ar (r#m %enerat#r as p#ssi&le

-ave &ack$p plan (#r device (ail$re

-ave meth#d #ther than ,OG (#r assessin%

circ$lati#n

-ave ma%net availa&le in 6)

,l t t !


91/108

91

,lectr#ca$tery !se

Place %r#$ndin% pad as (ar (r#m %enerat#ras p#ssi&le

Place %r#$ndin% pad as near t# s$r%ical

(ield as p#ssi&le!se &ip#lar electr#ca$tery i( p#ssi&le

-ave s$r%e#n $se sh#rt &$rsts #(electr#ca$tery

7S1 sec 510 sec#nds apart

'aintain l#3est p#ssi&le c$rrent

,l t t !


92/108

92

,lectr#ca$tery !se

I( ca$tery ca$ses asyst#le place ma%net#ver c#ntr#l $nit H chan%e (r#m

inhi&ited t# (ied m#de

Chan%e &ack a(ter3ards.e alert (#r ) #n T phen#men#n

P#st#perative C#nsiderati#ns


93/108

93

P#st#perative C#nsiderati#ns

Av#id shiverin%

-ave device checked and repr#%rammed i(

$esti#ns arise a$t its ($ncti#n

, l ( )h th


94/108

94

,amples #( )hythms

"ensin%Patients #3n &eat is sensed &y pacemaker s# d#es n#t (ire

, l ( )h th


95/108

95

,amples #( )hythms

!ndersensin%Pacemaker d#esnt sense patients #3n &eat and

(ires 7sec#nd last &eat

, l ( )h th


96/108

96

,amples #( )hythms

6versensin%

Pacemaker senses heart &eat even th#$%h it isnt &eatin%@/#te the l#n% pa$ses@

, l ( )h th


97/108

97

,amples #( )hythms

Capt$re

Pacemaker #$tp$t 7spike is (#ll#3ed &y ventric$lar

p#lariati#n 73ide )"@

, l ( )h th


98/108

98

,amples #( )hythms

/#ncapt$re

Pacer stim$l$s (ails t# ca$se my#cardial dep#lariati#n

Pacer spike is present &$t n# ,CG 3ave(#rm

Fires but fails to capture

Undersensing-

Fails to sense

ECG

Pacer spikes after theQRS

Oversensing-Fails to fire

, l ( )h th


99/108

99

,amples #( )hythms

100 = Atrial Paced )hythm 3ith 100= Capt$re

, amples #( )h thms


100/108

100

,amples #( )hythms

100= Ventric$lar Paced )hythm 3ith 100=Capt$re

,amples #( )hythms


101/108

101

,amples #( )hythms

100= Atrial and 100= Ventric$lar Paced )hythm3ith 100= Capt$re

,amples #( )hythms


102/108

102

,amples #( )hythms

50= Ventric$lar Paced )hythm 3ith 100= Capt$re

,amples #( )hythms


103/108

103

,amples #( )hythms

5= Ventric$lar Paced )hythm 3ith 100= Capt$re7/#te the sensin% that #cc$rs@ Pacer sensesintrinsic -) and d#esnt (ire@

,amples #( )hythms


104/108

104

,amples #( )hythms

AICD "h#ck #( VTC#nverted t# /")

,amples #( )hythms


105/108

105

p y

,amples #( )hythms


106/108

106

,amples #( )hythms

,amples #( )hythms


107/108

107

,amples #( )hythms

DDD Pacemaker

)e(erences


108/108

)e(erences

'#ser "A Cra3(#rd D Th#mas A@ AICDs@CC Nurse@ 1994E4@

/a%elha$t NN a%lanicny O?@ Nurse

Anesthesia. Philadelphia "a$nders@199@

6$ellette "@ 7000@ Anesthetic c#nsiderati#ns inpatients 3ith cardiac assist devices@ CNRA,237 90@

)#th N@ 7199

cardiac pacemakers new

Documents

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