Download - Pacemaker implantation in India
Pacemaker Implantation
Temporary Cardiac Pacing
• Transvenous• Transcutaneous• Epicardial• Transesophageal
Indications for Temporary Pacing
Acute myocardial infarction with: CHB, Mobitz type 2 AV block, medically
refractory symptomatic bradycardia, alternating BBB, new bifascicular block, new BBB with anterior MI
In absence of acute MI : SSS, CHB, Mobitz type 2 AV block
Treatment of tachyarrhythmias : VT
Permanent Pacing
The Pacemaker System
• PatientLead
Pacemaker
• Programmer
LeadLead PacemakerPacemaker
Pacemaker Implantation
• Transvenous :• Generator implanted anterior to pectoral muscle• Atrial/Ventricular leads via subclavian or cephalic
vein• Sensing and pacing threshold• Chest X-ray for pneumothorax, lead position
Acute Complications of Pacemaker Implantation
• Venous access Pneumothorax, hemothorax Air embolism Perforation of central vein Inadvertent arterial entry
• Lead placement Brady – tachyarrhythmia Perforation of heart, vein Damage to heart valve
• Generator Pocket hematoma Improper or inadequate connection of lead
Delayed Complications of Pacemaker Therapy
• Lead-related Thrombosis/embolization SVC obstruction Lead dislodgement Infection Lead failure Perforation, pericarditis
• Generator-related Pain Erosion, infection Migration Damage from radiation, electric shock
• Patient-related Twiddler syndrome
Codes Describing Pacemaker Modes
PositionPosition 11 22 33 44 55FunctionFunction ChambeChambe
rs Pacedrs PacedChamberChambers Senseds Sensed
ResponsResponse to e to SensingSensing
Rate Rate ModulatiModulationon
MultisitMultisite e pacingpacing
Specific Specific DesignatiDesignati
onsons
OO=none=none
AA=Atrium=Atrium
VV=Ventric=Ventriclele
DD=Dual-=Dual-Atrium Atrium and and VentricleVentricle
OO=none=none
AA=Atrium=Atrium
VV=Ventricl=Ventriclee
DD=Dual-=Dual-Atrium and Atrium and VentricleVentricle
OO=none=none
TT=Trigger=Triggereded
II=Inhibite=Inhibitedd
DD=Dual-=Dual-Triggered Triggered and and InhibitedInhibited
OO=none=none
RR=Rate =Rate modulationmodulation
OO=none=none
AA=Atriu=Atriumm
VV=Ventri=Ventriclecle
DD=Dual-=Dual-Atrium Atrium and and VentricleVentricle
NASPE/BPEG 2002
Indications for Pacing for AV BlockDegreeDegree Pacemaker necessaryPacemaker necessary Pacemaker Pacemaker
probably probably necessarynecessary
Pacemaker not Pacemaker not necessarynecessary
ThirdThird Symptomatic congenital Symptomatic congenital complete heart blockcomplete heart block
Aquired symptomatic complete Aquired symptomatic complete heart blockheart block
Atrial fibrillation with complete Atrial fibrillation with complete heart blockheart block
Acquired asymptomatic Acquired asymptomatic complete heart blockcomplete heart block
SecondSecond Symptomatic type ISymptomatic type I
Symptomatic type IISymptomatic type II
Asymptomatic Asymptomatic type IItype II
Asymptomatic Asymptomatic type I at intra-His type I at intra-His or infra-His levelsor infra-His levels
Asymptomatic type Asymptomatic type I at supra-His (AV I at supra-His (AV nodal) blocknodal) block
FirstFirst Asymptomatic or Asymptomatic or symptomaticsymptomatic
Indications for Pacing for Sinus Node Dysfunction
PacemakerPacemaker Pacemaker probably Pacemaker probably necessarynecessary
Pacemaker not Pacemaker not necessarynecessary
Symptomatic bradycardiaSymptomatic bradycardia Symptomatic patients with Symptomatic patients with sinus node dysfunction sinus node dysfunction with documented rates of with documented rates of <40 bpm without a clear-<40 bpm without a clear-cut association between cut association between significant symptoms and significant symptoms and the bradycardiathe bradycardia
Asymptomatic sinus node Asymptomatic sinus node dysfunctiondysfunction
Symptomatic sinus Symptomatic sinus bradycardia due to long-bradycardia due to long-term drug therapy of a term drug therapy of a type and dose for which type and dose for which there is no accepted there is no accepted alternativealternative
Pacemaker Follow-up
• GOAL OF FOLLOW-UP– Verify appropriate pacemaker operation– Optimize pacemaker functions– Document findings, changes and final settings in
order to provide appropriate patient management
Bi-Ventricular Pacing
Coronary sinus lead
Right atrial lead
Right ventricular lead
“Pacemaker Syndrome”
• Fatigue, dizziness, hypotension• Caused by pacing the ventricle asynchronously,
resulting in AV dissociation or VA conduction• Mechanism: atrial contraction against a closed AV
valve and release of atrial natriuretic peptide• Worsened by increasing the ventricular pacing rate,
relieved by lowering the pacing rate or upgrading to dual chamber system
• Therapy with fludrocortisone/volume expansion NOT helpful
World Health Expert
World Health Expert India (WHEI) offers patients across the world access to International Quality Medical Treatment at affordable rates with a saving of 30% to 70% on overall medical treatments in the US and other countries.
Get Pacemaker Implementation at World Health Expert
Package: $6000, 4 Days Stay
Contact Us
Website – http://www.worldhealthexpert.com/
Email – [email protected]
Number - +91 - 8826134489, 8447314061