Pacemaker/Defibrillator Flashcards
Indications for pacemaker placement:
Sick sinus syndrome
3rd degree AV block
Symptomatic 1st or 2nd degree AV block
Indications for AICD placement:
Pts at high risk for ventricular tachycardia and v fib. Patients at high risk for sudden cardiac death
Previous MI with V tach and V fib
Pacemaker Nomenclature: What are the 5 positions, and what are the 4 options for each of the 5 positions?
1: Chamber being paced
2: Chamber being sensed
3: Response of device to sensed event
4: Programmability and rate modulation
5: Multi-site pacing
O: no chamber sensed, paced, no response, no programmability, no chamber paced (multi site)
A: atria
V: Ventricle
D: Dual
Placing a magnet over the pacemaker will do what:
For most pacemakers-it will place it in an asynchronous mode (no sensing occurs)
Placing a magnet over an AICD will do what:
Will most commonly disable the defibrillation option
When approaching a patient with a pacemaker/aicd, what are the underlying questions that you are asking yourself?
What is the underlying rhythm, what is the state of the device (battery charge, lead integrity), and what the device does in the presence of a magnet.
When do you want to get a CXR in a pt with a pacemaker or AICD?
CXR: depending on how long device has been in place, and /or if you are planning a central line for a given procedure.
What situation s would make a pacemaker not capture?
Ischemia
Acidosis
Anti-arrhythmic medications
Electrolyte disturbances
Now, as far as what you’re planning when a patient presents for an elective surgery with a Pacemaker? Given that this patient has an underlying Brady rhythm, what are you gonna reprogram it to?
If there is no record of recent interrogation, the device should be studied prior to proceeding. Brady of 60? Then, make sure it is asynchronous with rate of 70 in order to prevent under and over sensing by device
