PACEMAKER
Presented by,
Miss. Soniya Joseph.
1st MSc Nursing
•PACEMAKER?
DEFINITION
“Pacemakers are electronic devices that can be
used to initiate the heartbeat when the heart’s
intrinsic electrical system cannot effectively
generate a rate adequate to support cardiac
output”.
History of pacemaker
TYPES OF
PACEMAKER
TEMPORARY PACEMAKER….
PERMANENT PACEMAKER….
TEMPORARY PACEMAKERS
INDICATIONS:
Bradycardia.
Tachydysrhythmias.
Permanent pacemaker failure.
Support cardiac output after surgery.
Diagnostic studies.
THE PACEMAKER SYSTEM
A simple electrical circuit consisting of….
PULSE GENERATOR
PACING LEAD
PACING PULSE GENERATOR
PACING LEAD SYSTEM
BIPOLAR PACING SYSTEM
UNIPOLAR PACING SYSTEM
PACING LEAD SYSTEM
BIPOLAR UNIPOLAR
Methods of pacing
1)Percussive pacing/ Transthorasic
2)Transcutaneous pacing
3)Epicardial pacing
4)Transvenous pacing
METHODS OF PACING…………
Percussive transcutaneous
CONT…….
EPICARDIAL TRANSVENOUS
PACING…. PACING….
TRANSVENOUS PACING
It Involves Threading An Eletrode Catheter Through A Vein Into
The Right Atrium Or Rt Ventricle.
FIVE DIFFERENT VEINS CAN BE
USED…
Antecubital Vein
Femoral Vein
Subclavian Vein
Internal Jugular
Vein External
Jugular Vein
SUBCLAVICULAR
PACEMAKER….
• Adv. Of Lithium iodide battery:
1) High energy density
2) Long shelf life
3) Internal self discharge
4) Predictable characteristic that allow early warning of battery
depletion
• LIFE SPAN--- SCP-----7 to 12 yrs
DCP---- 6 to 10 yrs
• Most pacemaker generate 2.8v at the beginning of
life & end @ 2.1 to 2.4v.
PACEMAKER
PACING SITE
ATRIAL VENTRICULAR
Single site Rt atrial appendages RV apex
Prior cardiac surgery Atrial septum/Lat wall His bundle
Dual site Rt atrial appendages RV apex
Coronary sinus ostium LV through coronary sinus
PACING & SENSING?
PACING---
When the delivered pacemaker impulse results in depolarisation
of
the corresponding cardiac chamber, it indicates successful pacing or
capture.
SENSING---
Pacemakers also detect & respond to the intrinsic cardiac activity
and this is known as sensing. When an intrinsic event is sensed, the
pacemaker does not initiate the electrical impulse in the same
chamber(inhibited) to prevent interference with the cardiac activity.
Sensing &
detection
MODES OF PACEMAKER
CONT
Pacing Modes
… Description
Asynchronous
AOO Atrial pacing, no
sensing
VOO Ventricular
pacing,no
DOO sensing
Atrial and ventricular
pacing, no sensing
PACING MODES
Pacing Modes Description
Synchronous
Atrial pacing, atrial sensing,
AAI inhibited response to sensed P wave
VVI Ventricular pacing, ventricular
sensing, inhibited response to sensed
QRS complexes
DVI Atrial and ventricular pacing,
ventricular sensing; both atrial and
ventricular pacing are inhibited if
a spontaneous ventricular
depolarization is sensed.
Pacemaker settings…
Rate
Output
Sensitivity
PACING ARTIFACT
The pacing artifact is the spike that is seen on the ECG tracing as the
pacing stimulus is delivered to the heart.
A P wave is visible after the pacing artifact if atrium is being
paced.
CONT….
.
MODES
SINGLE CHAMBER PACEMAKER.
DUAL CHAMBER PACEMAKER.
BIVENTRICULAR PACEMAKER.
SINGLE CHAMBER PACEMAKER
Carries electrical impulses from pulse generator to
the right ventricle of the heart.
Carries electrical impulses from pulse generator to the right ventricle of the heart.
DUAL CHAMBER PACEMAKER
Carries electrical impulses from pulse generator to
both the right ventricle and right atrium of the heart.
BIVENTRICULAR PACEMAKER
Stimulates both the lower chambers of the heart.
Cardiac Resynchronisation Therapy.
RISKS
Infection.
Allergic reaction .
Swelling, bleeding, bruising at the generator site.
Damage to the blood vessels or nerves.
Collapsed lung.
PREPARATION
• Electrocardiogram.
• Holter monitoring.
• Echocardiogram.
• Stress Test.
PERIOPERATIVE MANAGEMENT
Require preoperative determination of:
1)pacemaker dependency
2)device model
3)type of lead
4)plan to use electrocautery
• Surgery below the umbilicus have a
lower risk for
BEFORE THE PROCEDURE
Preparation room
IV Line
Local anesthesia.
X-ray.
ECG.
DURING THE PROCEDURE
X-RAY
ECG Monitoring.
AFTER THE PROCEDURE
• ENSURE CORRECT POSITION.
• PERIODIC CHECK UPS.
Pacemaker complication
• Pneumothorax
• Cardiac perforation
• Hematoma
• Venous occlusion
• Infection
• Lead dislodgement
• Diaphragmatic
stimulation
• Twiddler syndrome
• Pacemaker syndrome
Pacemaker syndrome
• Cause—1)loss of AV synchrony
• 2)presence of ventriculoatrial
contraction
• Atrial contraction against closed AV valves----leads to increased in Jugular
&
pulmonary venous pressure..
• C/F --- neck pulsation,fatigue,palpitation,cough,chest fullness,choking
sensation,orthopnoea,syncope,confusion,altered mental state etc..
PACEMAKER MEDIATED TACHYCARDIA
• In patient with intact VA
conduction,a premature
ventricular contraction may t
resul in retrograde conduction
to the atria,which,if outside the
PVARP, is sensed & followed by
ventricular pacing after the
programmed AV interval.
• The paced ventricular event
will again be followed by VA
conduction,resulting in endless
loop tachycardia..
Drug interaction
• FLECAINIDE--- may increase pacing
thresholds.
• B-blockers----- prolong AV conduction & increased rt
ventricular
.
.
. pacing.
• HYPERKALEMI
A
SPECIAL PRECAUTIONS
Cell phones.
Security systems.
Medical equipment.
Power generating equipment.
