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.