PACER IMPLANTATION

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PACEMAKER IMPLANTATION : 

PACEMAKER IMPLANTATION IMPLANTATION SITE LEAD ACCESS LEAD PLACEMENT INTRAOPERATIVE MEASUREMENTS PACER - LEAD CONNECTION

IMPLANTATION SITE : 

IMPLANTATION SITE PRE-PECTORAL (RIGHT OR LEFT SIDE) INTRATHORACIC OR ABDOMINAL (IN PAEDIATRIC PATIENTS)

LEAD ACCESS : 

LEAD ACCESS CEPHALIC VEIN - BETTER ACCESS BUT TIME CONSUMING SUBCLAVIAN PUNCTURE - EASIER ACCESS BUT CHANCES OF PUNCTURED ARTERY, OR OF A NERVE. POST IMPLANT - LEAD FRACTURE EXTERNAL JUGULAR - EASIER ACCESS BUT LEAD HAS TO BE TUNNELLED BACK TO THE PREPECTORAL AREA.

LEAD PLACEMENT : 

LEAD PLACEMENT VENTRICULAR LEAD - WITHDRAW STYLET A FEW cms (STYLET TIP CAN BE GIVEN A GENTLE CURVE), LEAD ADVANCED TO THE RV, STYLET READVANCED AND LEAD POSITIONED AT THE RV APEX ATRIAL LEAD - USUALLY A SCREW-IN LEAD (OR A TINED LEAD) PLACED IN THE RIGHT ATRIAL APPENDAGE. LEAD TIP CAN HAVE A PREFORMED ‘J’ OR CAN BE DONE WITH A PREFORMED ‘J’ STYLET

INTRAOPERAIVE MEASUREMENTS : 

INTRAOPERAIVE MEASUREMENTS PACING THRESHOLD (V) LEAD IMPEDANCE (OHMS) SENSING THRESHOLD (Mv) or R-WAVE / P-WAVE SLEW RATE (Dv/Dt) DIAPHRAGMATIC PACING @ 10V CURRENT (MA)

INTRAOPERATIVE MEASUREMENTS-OPTIMAL VALUES- : 

INTRAOPERATIVE MEASUREMENTS-OPTIMAL VALUES- PACING THRESHOLD (STEROID LEADS) - 1.5 V max LEAD IMPEDANCE - 300 TO 1000 ohms R-WAVE - > 7.0 MV P-WAVE - 2.0 to 4.0 MV SLEW RATE - > 0.75 DIAPHRAGMATIC PACING - NONE @ 10 V CURRENT - WHEN PACING, FLUCTUATIONS SHOULD BE WITHIN (+) or (-) 0.5 ma

INTRAOPERATIVE MEASUREMENTS : 

INTRAOPERATIVE MEASUREMENTS PACING THRESHOLD - MINIMUM AMOUNT OF CURRENT NEEDED TO STIMULATE THE HEART IMPEDANCE - DYNAMIC RESISTANCE ie., WHEN LEAD IS CONNECTED TO THE PACER R-WAVE / P-WAVE - INTRACARDIAC SIGNAL SENSED BY THE PACER SLEW RATE - CHANGE IN SLOPE OF R-WAVE / P-WAVE AGAINST TIME (FASTEST SLEW RATE SHOULD BE SOUGHT ie., 1 mv/ms IS FASTER THAN 0.5 mv/ms) CURRENT - SHOULD BE USED TO CHECK LEAD STABILITY

PACER - LEAD CONNECTION : 

PACER - LEAD CONNECTION LEADS ARE TIED BY USE OF ANCHORING SLEEVE TO THE MUSCLE AFTER ENSURING THERE IS ENOUGH LOOP. THEN THE FINAL THRESHOLD CHECK IS DONE BEFORE CONNECTING THE LEAD TO THE PACER

PACER - LEAD CONNECTION : 

PACER - LEAD CONNECTION EXCESS LENGTH OF THE LEADS IS PLACED UNDER THE PACEMAKER CAN TO MINIMIZE RISK OF DAMAGE DURING PACER REPLACEMENT IN CASE THE PATIENT IS UNDER INTRINSIC RHYTHM, THE WORKING OF THE PACER CAN BE CHECKED BY A STERILE MAGNET

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