Single Chamber Temporary Pacing Operations

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Single Chamber Temporary PacingOperations
Troubleshooting
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Temporary Pacing Indications
Sick Sinus Syndrome (Patient Must Be Symptomatic
and Documented with ECG)

• Symptomatic sinus bradycardia
• Symptomatic sinus arrest
• Suppression of ventricular ectopy resulting from
  bradycardia
• Atrial fibrillation
• Bradycardia/Tachycardia syndrome

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Temporary Pacing Indications
Heart Blocks

• Type I and Type II second degree AV block
• Acute bifascicular or trifascicular block
• Complete AV block
• Cardiac arrest with ventricular asystole

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Other Temporary Pacing Indications
Drug-Refractory Dysrhythmia

• Overdrive ventricular pacing to suppress or
  prevent VEA (Ventricular Ectopic Activity)
• Overdrive atrial pacing to break SVT, atrial
  flutter

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Other Temporary Pacing Indications
Cardiovascular Surgery

• Coverage for anesthesia and surgery in patients
  with positive cardiac history
• Treatment for CHB development during surgery
• Augment cardiac output post operatively

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Other Temporary Pacing Indications
Diagnostic Uses

• SSS pacing studies to determine SA node recovery
• Stress testing for Coronary Artery Disease
• Electrophysiologic (EP) studies

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Insertion Sites
Internal Jugular Vein
External Jugular Vein
Subclavian Vein
Brachial Vein
Femoral Vein
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Lead Types
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Lead Types

• Endocardial/Transvenous lead
• Transvenous lead is introduced into a vein and
  advanced into the heart
• Epicardial/Myocardial lead
• An epicardial lead attached to the outside of the
  heart is introduced through the chest wall

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Lead Types

• Bipolar lead system
• The negative and positive electrodesare in
  contact with the heart

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Lead Types

• Unipolar lead system
• The negative electrode is in contact with the
  heart and the positive (or ground) electrode is
  located elsewhere on the body

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Cable Connectors

• Connector pins on the lead(s) must be fully
  inserted in the patient connector block
• Observe polarity
• Distal negative
• Proximal positive
• Finger tighten only no tools!

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Temporary Pacing Parameters

• Pacing rate (heart rate)
• Output/stimulation threshold
• Sensitivity

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Pacing Rate
Paced Interval
Paced Interval
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Output
Output Pulse
Output/Current(ma)
Pulse Width(ms)

• The output dial regulates the current or movement
  of electrons

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Capture

• Depolarization of cardiac musclefollowing an
  electrical stimulus

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Stimulation Threshold

• The minimum output pulse neededto consistently
  capture the heart

3 mA
2 mA
1 mA
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Lead Maturation
x3
x2
Threshold Amplitude
Initial
1
2
3
4
5
10
15
Days Since Leads Applied
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Sensitivity

• The degree that the pacing system sees or
  senses signals, controlled by the sensitivity
  setting which is graduated in millivolts (mV)

Sensitivity (mV)
5 (mV)
2.5 (mV)
1.25 (mV)
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Sensitivity

• The lower the setting, the more sensitive the
  pacemaker is to intracardial signals

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NBG Codes
1st Letter
2nd Letter
3rd Letter

• Chamber(s) Paced
• A atrium
• V ventricle
• D dual (both atrium and ventricle)

Chamber(s) Sensed A atrium V ventricle D dua
l O none
Response to Sensing I inhibit (Demand
mode) T triggered D dual O none (Asynch)
Chamber paced
Chamber sensed
Action or response to a sensed event
V
V
I
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VVI Demand/Inhibited

• Pacemaker senses intrinsic depolarization
• Paces the heart when the patients own rate
  becomes slower than the pacemaker

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Ventricular Inhibited Mode (VVI)
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VOO Asynchronous (Fixed)

• Pacemaker will emit an output at a fixed
  rateregardless of intrinsic activity

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Ventricular Asynchronous Mode (VOO)
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Single Chamber Troubleshooting Process

• 1. Gather information
• 2. Identify the problem and possible cause
• 3. Identify the solution and carry
  outcorrective procedures

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Information Gathered

• Patient data
• Pacemaker information
• Lead information
• Non-invasive tools

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Undersensing

• Failure of the pacemaker to senseintrinsic
  R-waves or intrinsic P-waves

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Undersensing
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Oversensing

• Inhibition of the pacemaker by events
  thepacemaker should ignore, e.g. EMI,
  T-waves,and myopotential

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Oversensing
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Loss of Capture
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Loss of Output
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Fusion/Pseudofusion Beats
Intrinsic Beat
Paced Beat
Intrinsic Beat
Paced Beat
Fusion Beat
Pseudofusion Beat
Fusion Beat
Pseudofusion Beat
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Electromagnetic Interference (EMI)

• Radiated or conducted energy either electrical
  or magnetic which can interfere with the
  function of the pacemaker in the Demand mode

(EMI)
Should havepaced
2.5 mV
80
80