Pacemaker & management

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Pacemaker & management : 

Pacemaker & management

What is a P? : 

What is a P? A device for increasing a slow HR A device used primarily to correct some types of bradycardia, or slow hrt rhythms.

Who would need it ? : 

Who would need it ?

Slide 5: 

Absolute indications Sick sinus syndrome Symptomatic sinus bradycardia Tachy-brady syndrome Afib with slow ventricular response CHB Inability to increase heart rate to match exercise Prolonged QT syndrome

Pacemaker Indications : 

Pacemaker Indications Relative indications Cardiomyopathy Dilated Hypertrophic Severe refractory neurocardiogenic syncope Paroxysmal atrial fibrillation

How does it work ? : 

How does it work ? Attach P system Pulse generator Sensing and Pacing leads Make it into a circuit Put system into the body / under skin & join to heart by pacing wire Program it’s function by the programmer

Pacing Systems : 

Pacing Systems Pulse generator Sensing and Pacing lead

The Pacemaker System : 

The Pacemaker System Patient Lead Pacemaker Programmer

Connection to Pacemaker : 

Connection to Pacemaker

Just a Simple Lead : 

Just a Simple Lead

Lead System : 

Lead System A lead is insulated wire used to connect pulse generator to cardiac tissue Lead transmits energy to myocardium & relays intrinsic cardiac signals back to sensing circuit

Components of a Pacing Lead : 

Components of a Pacing Lead Connector Proximal Ring Electrode Lead Body Active Fixation Mechanism Suture Sleeve Distal Tip Electrode

Fixation Mechanisms : 

Fixation Mechanisms Active fixation Screw-in lead Passive fixation Tined tip Passive fixation Finned tip

Pacemaker Circuit : 

Pacemaker Circuit Unipolar VS Bipolar

Unipolar Vs. Bipolar : 

Bipolar Unipolar Unipolar Vs. Bipolar + + -

Bipolar Pathway : 

Bipolar Pathway - +

Unipolar Pathway : 

Unipolar Pathway + + -

Unipolar : 

Unipolar

Bipolar Configuration : 

Bipolar Configuration

Lead Placement : 

Lead Placement

Ventricular Lead Placement : 

Ventricular Lead Placement

Ventricular Lead Placement : 

Ventricular Lead Placement

Ventricular Lead Placement : 

Ventricular Lead Placement

Atrial Lead Placement : 

Atrial Lead Placement The atrial lead should be implanted on the septal wall of the atrial appendage Once the lead is in the proper position it will have a “wagging” appearance

Atrial Endocardial Placement : 

Atrial Endocardial Placement

Atrial Endocardial Placement : 

Atrial Endocardial Placement

Atrial Endocardial Placement : 

Atrial Endocardial Placement Ventricle Atrium

Atrial Endocardial Placement : 

Atrial Endocardial Placement

Single Chamber Pacing : 

Single Chamber Pacing One Lead One Circuit / Pacemaker One Patient

Dual-Chamber Pacing : 

Dual-Chamber Pacing

Slide 32: 

The NASPE/BPEG Generic (NBG) Code Position Category Letters Used Manufac- turer’s Designation Only I II III Chamber(s) Paced Chamber(s) Sensed Response to Sensing Rate modulation Multisite pacing O-None P-Simple Programmable M-Multi- Programmable C-Communicating R-Rate modulation O-None A-Atrium V-Ventricle D-Dual (A+V) S- Single (A or V) S- Single (A or V) O-None A-Atrium V-Ventricle D-Dual (A+V) O-None T-Triggered I-Inhibited D-Dual (T+I) O-None A-Atrium V-Ventricle D-Dual (A+V) IV V Version 2001

Common Pacemaker Modes : 

Common Pacemaker Modes - Ventricular pacing - No sensing - No response to sensing

Common Pacemaker Modes : 

Common Pacemaker Modes - Ventricular pacing - Ventricular sensing - Inhibited when sensing a ventricular event

Common Pacemaker Modes : 

Common Pacemaker Modes - Ventricular pacing - Ventricular sensing - Inhibited when sensing a ventricular event - Rate response capabilities

Common Pacemaker Modes : 

Common Pacemaker Modes - Dual (Atrial & Ventricular) pacing - Dual (Atrial & Ventricular) sensing - Dual (Inhibited & Triggered) response to sensing

Common Pacemaker Modes : 

Common Pacemaker Modes Programmability & Rate Response - Dual (Atrial & Ventricular) pacing - Dual (Atrial & Ventricular) sensing - Dual (Inhibited & Triggered) response to sensing - Rate Response Capabilities

Common Misconceptions About P : 

Common Misconceptions About P

Slide 39: 

"With pacemaker I cannot use cellphone.“ Although possibility of interference with some high-power digital cell phones, ppl with pacemakers usually need only to keep phone out of clothing pockets near pacemaker & hold phone to ear away from pacemaker.

Slide 40: 

"With pacemaker I cannot use a microwave oven." True for very old pacemakers but not true today. Ppl may use all household appliances.

Slide 41: 

"With pacemaker I will ‘ve to slow down." This is false, play any sports. Can even participate in strenuous activities such as marathons or scuba diving after consultation with their cardiologists.

Slide 42: 

"With pacemaker I cannot travel." Carrying ID card given at time of P implantation, pats can ve their P evaluated in almost any part of world if needed. It is also safe to pass through airport security checks in normal fashion.

Slide 43: 

"With my PI won’t need heart medications." P doesn’t replace need for hrt medi to t/t > BP, angina, etc.

Slide 44: 

"I ‘ve a P, so I can’t have a hrt attack." P doesn’t protect against blockages in blood vessels. With P implants, pats should continue to follow a hrt-healthy lifestyle that includes exercise, diet, & cardiac medi.

Slide 45: 

Thank You

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