Pacemaker complication: Difference between revisions
Kurtucla05 (talk | contribs) (new section- ECG changes with pacemaker) |
Kurtucla05 (talk | contribs) (added plain film section) |
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#Simulataneous depol of ventricles produces dominant R wave in V1 | #Simulataneous depol of ventricles produces dominant R wave in V1 | ||
==Plain Film Findings== | |||
#Obtain PA/Lateral Films to confirm pulse generator, manufacturer, lead placement/number/integrity | |||
#R atrial lead J shaped(tip medially on AP) entering right atrial appendage | |||
#RV leads point downward with tip between left spine and cardiac apex--lateral XR shows inferior and anterior | |||
#Coronary sinus lead- courses posteriorly on lateral XR | |||
#Extra leads may be appropriately abandoned and capped | |||
#ICD component appears as thickened shock coil | |||
==Pacemaker Malfunction== | ==Pacemaker Malfunction== | ||
===Problems with pocket=== | ===Problems with pocket=== |
Revision as of 01:09, 6 September 2014
Nomenclature
- Position I
- Chamber paced (A, V, or D (dual))
- Position II
- Chamber sensed
- Position III
- Response after Sensing
- I = inhibited
- T = triggered
- D = Dual
- Response after Sensing
- Position IV
- Programmability
- P = rate & output
- M = multiprogramable
- C = communicating
- R = rate adaptive
- O = none
- Programmability
- Position V
- Arrhythmia Control
- P = pacing
- S = shock
- D = dual (P+S)
- O = none
- Arrhythmia Control
Indications
- Sinus Node Dysfunction-sinus bradycardia/arrest, sinoatrial block, chronotropic incompetence, a-fib.
- Acquired AV block- 3rd degree block and 2nd degree type II
- Chronic Bifascicular or Trifascicular block
- After Acute MI-high mortality with persistent AV block post MI
- Cardiac Resynchronization Therapy- Conduction delay (>150msec w/ mortality benefit) in chronic systolic heart failure further decreases EF, increases remodeling and increased MR.
- Neurocardiogenic Syncope and Carotid Sinus Syndrome
Expected ECG Patterns
- Absence of pacer artifact indicates intrinsic depolarization
- Pacing artifacts preceding depolarizations indicate successful pacing and capture
- Leads in RV apex produce LBBB pattern with appropriate discordance
- New RBBB pattern may indicate lead in LV
- Simulataneous depol of ventricles produces dominant R wave in V1
Plain Film Findings
- Obtain PA/Lateral Films to confirm pulse generator, manufacturer, lead placement/number/integrity
- R atrial lead J shaped(tip medially on AP) entering right atrial appendage
- RV leads point downward with tip between left spine and cardiac apex--lateral XR shows inferior and anterior
- Coronary sinus lead- courses posteriorly on lateral XR
- Extra leads may be appropriately abandoned and capped
- ICD component appears as thickened shock coil
Pacemaker Malfunction
Problems with pocket
- Infection
- Most commonly Staphylococcus aureus or S. epidermidis
- Hematoma
- Typically occurs shortly after placement
Problems with leads
- Lead separation results in failure to capture
- Lead dislodgment may cause thrombosis or myocardial rupture
- Lead infection can cause severe sepsis
Failure to pace
- Causes include battery exhaustion, wire fracture, or electrode displacement
- Tissue reaction around electrode may make myocardium insensitive
Failure to sense
- Voltages of patient's intrinsic QRS complex is too low to be detected
- New intrinsic arrhythmia, AMI, electrolyte abnormalities, lead separation, battery depletion
Runaway Pacing
- Physiologic electrical activity (T waves, muscle potentials)
- External electromagnetic interference
- Signals generated by interaction of different portions of the pacing system
Work-Up
- CXR
- ECG
- Troponin
- Interrogation
Management
- Use magnet to convert pacemaker to asynchronous mode if oversensing or runaway pacing