3.10 Pacemaker Indications Flashcards
List the indications for a pacemaker
Temporary
1) Not A/W acute MI
2) Prophylactic
3) Following cardiac surgery
4) Following failure of perm system
Temporary
Associated w] acute MI - asystole - second or 3rd degree heart block w symptoms / following ant MI - Trifasicular block
Not A/W acute MI
- Symptomatic junctional Brady
- Tachy / Brady syndrome w) pauses
Prophylactic
Preop patients second / 3rd / Trifasic block
Permanent
Sympto 2nd or 3rd degree
Tachy brady w/ pauses
Post cardiac tplx w/ bradyarr
Paroxysmal SVTarr
Define nomenclature of PM
Chamber Paced
Chamber Sense
Response
Rate Response
Anti Tachy function
Chamber Paced
0 - None
A - Atrium
V - Ventricle
D - Dual
S - Single
Chamber sensed
0 - None
A - Atrium
V - Ventricle
D - Dual
S - Single
Response
0 - None
I - Inhibit
T - Trigger
D - Dual
Rate response
0 - None
R - Adapt
Anti- Tachycardia function
0 - None
P - ATP
S - Shock
D - Dual
Perioperative complications of patient NCS w/ PPM
Preop
Preop
Indication for PM - Significant Cardiac disease
Ask patient see PM card
Confirm last pacing check
Modificatin of function for srugery
Low threshold for check if not <6mo
Perioperative complications of patient NCS w/ PPM
Intraop
1) Sux
Fasciculation interpreted as:
- VF / trigger shock
- Representing electrical activity - subsequent d/c
2) Diathermy interpreted PM as native cardiac activity
inhibiting or activiting functions
- Constant interference detected = should default VVI
- Risk micro shock along pacing leads
- Char pacing wire insertion point =
increase threshold
decrease capture
peri and post op
Intra op complications
3 Use of magnet in modern PM - less predicatble
4 Defib pads should be placed direct over PPM
>12cm from generator
recommended safe distance
5 Avoid use of N2O in recent implanted
- accumulation can cause detachment of anode lead in Unipolar
Post Op
PPM check +/- reactivation of programmable functions
warranted
Shivering can cause myopotential generated
interpreted as cardiac activity
