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.

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Package: $6000, 4 Days Stay

Contact Us

Website – http://www.worldhealthexpert.com/

Email – treatment@worldhealthexpert.com

Number - +91 - 8826134489, 8447314061