ppt pacemaker

Pacing

Objectives

bull Indications for pacingbull NASPE BPEG nomenclaturebull Assessment reassessment of patient

Indications

bull Hemodynamically unstable bradycardiabull ndash Systolic blood pressure lt 80-90bull ndash Altered mental statusbull ndash AMI (chest pain angina)bull ndash CHF Pulmonary edemabull Failure of pharmacologic therapybull Risk of high degree AV blockbull Bradyasystolic cardiac arrestbull Overdrive pacing (SVT V tach)

Contraindications

bull Rhythm misinterpretationbull ndash Asystole mistaken as v-fibbull Severe hypothermiabull ndash May precipitate v-fib Correct temperature firstbull Relative Contraindicationbull ndash Bradyasystolic arrest lasting longer than 20bull minutes Chance of success is low

The Heart Has an Intrinsic Pacemaker

bull The heart generates electrical impulses thatbull travel along a specialized conduction pathwaybull This conduction process makes it possible forbull the heart to pump blood efficientlybull Remember the heartrsquos anatomy ampbull physiology

Ventricles

Sinoatrial (SA) Node

Atrioventricular (AV) Node

Atria

During Conduction an Impulse Begins in the Sinoatrial (SA) Node and Causes the Atria to

Contract

Atria

Ventricles

Bundle branches

AV node

SA node

Then the Impulse Moves to the Atrioventricular (AV) Node and Down the Bundle Branches Which Causes the

Ventricles to Contract

SA node

bull Prevent impulse generation in the SA node

bull Inhibit impulse conduction

AV node

Diseased Heart Tissue May

bull Pulse generator power source or battery

bull Leads or wiresbull Cathode (negative

electrode)bull Anode (positive

electrode)bull Body tissue

IPG

Lead

Anode

Cathode

Pacemaker Components Combine with Body Tissue to Form a Complete Circuit

bull Contains a battery that provides the energy for sending electrical impulses to the heart

bull Houses the circuitry that controls pacemaker operations

Circuitry

Battery

The Pulse Generator

bull Deliver electrical impulses from the pulse generator to the heart

bull Sense cardiac depolarization

Lead

Leads Are Insulated Wires That

bull Endocardial or transvenous leadsbull MyocardialEpicardial leads

Fixation Mechanismsbull Passive fixation

ndash The tines become lodged in the trabeculae(fibrous meshwork) of the heart

bull Active Fixation ndash The helix (or screw) extends into the endocardial

tissue

Types of Leads

Myocardial and Epicardial Leads

bull Leads applied directly to the heartndash Fixation mechanisms

includebull Epicardial stab-inbull Myocardial screw-inbull Suture-on

Cathodebull An electrode that is in contact

with the heart tissuebull Negatively charged when

electrical current is flowing

Anodebull An electrode that receives

the electrical impulse after depolarization of cardiac tissue

bull Positively charged when electrical current is flowing

CathodeAnode

Conduction Pathways

bull Body tissues and fluids are part of the conduction pathway between the anode and cathode

Tissue

Cathode

Anode

bull Begins in the pulse generator

bull Flows through the lead and the cathode (ndash)

bull Stimulates the heartbull Returns to the anode

(+)

During Pacing the ImpulseImpulse onset

Unipolar Pacingbull Current Flows through the tip

electrode (cathode)bull Stimulates the heartbull Returns through body fluid

and tissue to the IPG (anode)

Cathode

Anode

A Bipolar Pacingbull Flows through the tip electrode

located at the end of the lead wire

bull Stimulates the heartbull Returns to the ring electrode

above the lead tip

Anode

Cathode

Single-Chamber Systembull The pacing lead is implanted

in the atrium or ventricle depending on the chamber to be paced and sensed

Dual-Chamber Systemsbull Have Two Leadsbull One lead implanted in the

atrium bull One lead implanted in the

ventricle

METHODS OF PACING

Epicardialbull Used in patients that have undergone open heart surgerybull Temporary leads are placed on the epicardium during

surgery and exit through the chest wall

Transcutaneous Pads are placed on the chest or on the chestand back of a patient and attached to anexternal pulse generator

METHODS OF PACING

Implanted pulse generatorbull A small device is surgically placed in a

subcutaneous pocket

Transvenousbull Via central line a lead is thread down to the RV

Transcutaneous Pacingbull Simple procedurebull ndash Pacing padsbull ndash Easy to applybull ndash Non invasivebull ndash Most monitor-defibrillators are also pacersbull ndash Can be one person procedurebull ndash Pads to chest wallbull ndash Attached to monitor-defibrillatorbull ndash Bridge until more permanent device can be

inserted

Transvenous Pacingbull Invasive

ndash Equipment intensendash Invasivendash Exposure to bloodndash Requires at least 2 peoplendash Directly into heartndash Quick in hands of experienced practitionerndash Wire into Right Ventriclendash Attached to Pulse Generator

Types of pacemakersTemporary bull -Transvenous- pacing

wire via central line to RV under X rayusually bipolar ie with 2 electrodes at the end of wire

bull -Transthoracic-one electrode over cardiac apexother over right scapula or clavicle

bull -Epicardial Pacing

Permanent-bull a pulse generator is

implanted subcutaneouslyelectrodes usually unipolar ieone intracardiac electrodewith current returning to pacemaker via body

Pacemaker Configurations

Position

I II III IV VParameter measured

Chamberspaced

Chambers sensed

Response to endogenous depolarization

Rate modulation

Anti tachycardia function

Possible values

O = None O = None O = None O = None O = None

A = Atrium

A = Atrium

I = Inhibited R = Rate response on

P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual

NASPE North American Society of Pacing and Electrophysiology BPEG British Pacing and Electrophysiology Group

bullFor external pulse generators only positions I II amp III apply

Terminology

bull Atrial Tracking ndash A pacing mode in which the ventricles are paced in synchrony with sensed atrial eventsbull A-V Synchrony ndash The activation sequence of the heart in which the atria contract first and then after an appropriate delay the ventriclesbull Base Rate ndash The rate at which a pulse generator

emits a stimuli

Terminology

bull Dual Chamber Pacing ndash Pacing in both the atria and ventricles to artificially restore the natural contraction sequence of the heartbull Overdrive pacing ndash Pacing the heart at a rate faster than the patientrsquos intrinsic rhythm to suppress a tachycardia to gain electrical control of the heart or to suppress PVCs

Terminology

bull Asynchronous ndash Pacemaker which stimulates at a fixed preset rate independently of the electrical or mechanical activity of the heartbull Demand (inhibited) ndash Any pacemaker which after sensing a spontaneous depolarization withholds a pacing stimulusbull A-V Sequential ndash A dual chamber pacemaker which can pace and sense in both atria amp ventricles

Terminology bull Tracking ndash Pacemaker behavior in whichventricular pacing is synchronized to sensedatrial activitybull Triggered ndash The opposite of inhibited(demand) A triggered pacemaker upondetecting a spontaneous depolarization or othersignal will deliver an electrical stimulus to theheart

Pacing

bull The primary role of cardiac pacing is to augment or replace the hearts intrinsic electrical system

bull Cardiac pacing is repetitive stimulation of cardiac activity used to treat brady or tachyarrhythmias

bull Most modern units are Dual unitsworking in DDD mode providing atrial pacing in presence of atrial bradycardia amp ventricular pacing after atrial depolarisation if spontaneous ventricular beat is absent

bull Worldwide gt 250000 permanent cardiac pacemakers implanted each year As the population ages and as indications for pacemakers expand the number of implants continues to increase

Pacemaker Programmer

bull The programming computer allows telemetric communication with the implanted pulse generator and acts as an interface to the healthcare provider

bull The pacemaker programmer is used to perform a multitude of functions including assessing battery status modifying pacemaker settings and providing access to diagnostic information the pacemaker has stored (eg heart rate trends and tachyarrhythmia documentation

Assessment

bull Check monitorbull Check PULSEbull Check responsivenessbull Check BPbull Obtain 12 lead EKGbull Document pacer settings

AssessmentPost Transvenous Insertionbull Secure catheter ndash Usually sutured by the physicianbull Apply sterile dressingbull Secure pacing leads by looping them and taping

them outside the dressingbull Secure generator to patientbull Obtain CXR to verify lead placement and evaluate

for pneumothorax

Assessmentbull Detailed examination of cardiovascular systembull Identification of pacemakerdetermination of

pacemaker modeprimary indication for pacingbull Details of when device implantedwhen amp where

it was last checked anatomical position of current active generator

bull Pulse generator- battery statusreset mode information amp confirmation of satisfactory thresholds

Assessmentbull 12 lead ECG (1) All beats preceeded by a pacemaker

spikeassume patient is pacemaker dependent

(2) If native rhythm predominates-not pacemaker dependent

(3) If pacemaker spike not followed by P or QRS suspect pacemaker malfunction

Complications

bull Hemopneumothorax during insertionbull Bleeding at insertion sitebull Myocardial perforationbull Myocardial irritability gtgt dysrhythmiasbull Transient BBBbull Failure to achieve capture

Electro magnetic interference

bull Sources of EMI are found most commonly in Hospital Environments

bull Sources of EMI that interfere with pacemaker operation include surgicaltherapeutic equip such as

bull Electrocauterybull Transthoracic defibrillationbull Extracorporeal shock-wave lithotripsybull Therapeutic radiation


bull RF ablationbull TENS unitsbull MRI New technologies will continue to create

new unanticipated sources of EMIbull Cellular phones amp digital technology


Sources of EMI are found more rarely inbull Home office and shopping environmentsbull Industrial environments with very high electrical

outputsbull Transportation systems with high electrical energy exposure or with high-powered radar and radio transmission ndash Engines or subway braking systems ndash Airport radar ndash Airplane enginesbull TV and radio transmission sites

MEDTRONIC 5388bull Dual Chambered Pacemaker

Pacemaker ConfigurationsVOO

Indications

Temporary mode some-times used during surgery to prevent interference from electrocautery

Pacemaker ConfigurationsVVI

Indications

The combination of AV block and chronic atrial arrhythmias (particularly atrial fibrillation)

Pacemaker ConfigurationsAAI

Indications

Sick sinus syndrome in the absence of AV node disease or atrial fibrillation


Indications


Pacemaker ConfigurationsDDD

Indications1 The combination of AV block and SSS2 Patients with LV dysfunction and LV hypertrophy

who need coordination of atrial and ventricular contractions to maintain adequate CO

Problems with PacemakersFailure to Capture

Causes bull Threshold rise (electrolytes drugs)bull Lead dislodgementbull Lead fracturebull RV infarct

Braunwalds Heart Disease A Textbook of Cardiovascular Medicine 7th ed 2005

Problems with PacemakersFailure to Pace


Problems with PacemakersFailure to Sense


Example 1

Ventricular sensed ventricular paced

Consistent with VVI

The Alan E Lindsay ECG Learning Center httpmedstatmedutahedukwecg

Example 2

Atrial sensed ventricular paced

Consistent with DDD or VDD


Example 3

Atrial paced

Consistent with AAI or DDD


Example 4

Failure to Pace


Example 5

Failure to Sense


Paced Rhythm Recognition

VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120

Summary of Basic Pacing ConceptsModulebull 1048673Pacing systems

bull 1048673Electrical conceptsbull 1048673Stimulation thresholdsbull 1048673Sensingbull 1048673Electromagnetic Interference (EMI)bull 1048673Rate responsebull 1048673NASPE BPEG Nomenclature

Thank you

Pacing

Objectives

Indications

Contraindications


During Conduction an Impulse Begins in the Sinoatrial (SA) Node and Causes the Atria to Contract

Then the Impulse Moves to the Atrioventricular (AV) Node and Down the Bundle Branches Which Causes the Ventricles to Contract



The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways

During Pacing the Impulse

Slide 17

Slide 18

METHODS OF PACING

Slide 20

Transcutaneous Pacing

Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388

Pacemaker Configurations VOO

Pacemaker Configurations VVI

Pacemaker Configurations AAI

Slide 44

Pacemaker Configurations DDD

Problems with Pacemakers Failure to Capture

Problems with Pacemakers Failure to Pace

Problems with Pacemakers Failure to Sense

Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61

Summary of Basic Pacing Concepts Module

Slide 63

Objectives

bull Indications for pacingbull NASPE BPEG nomenclaturebull Assessment reassessment of patient

Indications


Contraindications




Ventricles



Atria


Contract

Atria

Ventricles

Bundle branches

AV node

SA node



SA node



AV node






IPG

Lead

Anode

Cathode




Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Indications


Contraindications




Ventricles



Atria


Contract

Atria

Ventricles

Bundle branches

AV node

SA node



SA node



AV node






IPG

Lead

Anode

Cathode




Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Contraindications




Ventricles



Atria


Contract

Atria

Ventricles

Bundle branches

AV node

SA node



SA node



AV node






IPG

Lead

Anode

Cathode




Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63



Ventricles



Atria


Contract

Atria

Ventricles

Bundle branches

AV node

SA node



SA node



AV node






IPG

Lead

Anode

Cathode




Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Atria

Ventricles

Bundle branches

AV node

SA node



SA node



AV node






IPG

Lead

Anode

Cathode




Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

SA node



AV node






IPG

Lead

Anode

Cathode




Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63





IPG

Lead

Anode

Cathode




Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63



Circuitry

Battery

The Pulse Generator



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63



Lead






tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63





tissue

Types of Leads










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63










CathodeAnode

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Conduction Pathways


Tissue

Cathode

Anode




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63




(+)





Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63




Cathode

Anode




above the lead tip

Anode

Cathode





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63





ventricle

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

METHODS OF PACING




METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

METHODS OF PACING


subcutaneous pocket



inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


inserted










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63










Position


Chamberspaced

Chambers sensed


Rate modulation


Possible values


A = Atrium

A = Atrium


P = Pace

V = Ventricle

V = Ventricle

T = Triggered

S= Shock

D = Dual (A + V)

D = Dual (A + V)

D = Dual (I + T)

D = Dual



Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Terminology


emits a stimuli

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Terminology


Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Terminology



Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


Pacing








Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63






Assessment




for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63



for pneumothorax









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63









Complications














Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63













Indications



Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


Indications



Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


Indications



Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


Indications












Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63











Example 1


Consistent with VVI


Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Example 2




Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Example 3

Atrial paced



Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Example 4

Failure to Pace


Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

Example 5

Failure to Sense



VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


VVI 60


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


DDD 60 120


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


VVI 60


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


AAI 60


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


DDD 60 120


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


DDD 60 120


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63


DDD 60 120



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63



Thank you

Pacing

Objectives

Indications

Contraindications






The Pulse Generator


Types of Leads


Slide 14

Conduction Pathways


Slide 17

Slide 18

METHODS OF PACING

Slide 20


Transvenous Pacing

Types of pacemakers

Slide 24

Terminology

Slide 26

Slide 27

Terminology

Pacing

Slide 30


Assessment

Slide 33

Assessment

Slide 35

Complications


Slide 38

Slide 39

MEDTRONIC 5388




Slide 44





Example 1

Example 2

Example 3

Example 4

Example 5


Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61


Slide 63

ppt pacemaker

Documents

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ventricular

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