Pacemaker complications

Question 1

65 yr m P/W bradycardia HR 30 , shocked , wide QRS on ECG , and CXR shows leads wrapped around device , what is your management

Answer 1

this is twiddlers syndrome
apply defib pads ( away from device )
place magnet on the device to deactivate
IVF boluse normal saline 1000 ML
atropine 600-1200 mcg IV aim HR >60
Adrenaline infusion , aim for SBP > 90
cardiology consult to replace device and wires

Question 2

what is the difference between failure of output and failure of capture ?

Answer 2

failure of output : no spikes

failure of capture : presence of spikes but no wave ( no QRS )

Question 3

Complications post PPM insertion

Answer 3

tamponade 
pneumothorax
haematoma 
dislodgement/ fracture of wires  
myocardial perforation 
delayed complications : twiddlers syndrome , infection '

Question 4

what is the effects of placing magnet over IDC and over PPM

Answer 4

magnet over IDC : turning defibrillation function off

magnet over PPM : ASYNCHRONISED pacing ( no sensing ) .