Introduction to Pacemakers

Posted by e-Medical PPT Sunday, November 18, 2012
General indications for a temporary pacemaker
Heart rate is slow, causing hemodynamic compromise
  Sick sinus syndrome
  Sinus bradycardia or atrial fibrillation with slow heart rate
response (generally <40 bpm)
Heart block
  3rd degree
  2nd degree type 2 (Mobitz)
Malignant Tachyarrhythmia caused by bradycardia
Torsades de Pointes

Clinical settings for temporary pacemaker
Syncope
Myocardial infarction
 Especially inferior
Shock due to bradycardia
Myocarditis
Lyme disease

Pacemaker Nomenclature
CommonModes
  VVI – Single chamber (ventricle)
  DDD – Dual chamber
  AAI (uncommon) – Single chamber (atrium)
1st Letter is chamber PACED
2nd Letter is chamber SENSED
3rd Letter is response
  I = Inhibit
  T = Triggered (Unusual)
  D = Dual (Inhibit or Pace)
4th Letter – R = Rate responsive (permanent pacers)

Sites of insertion for a temporary pacemaker
Right internal jugular
Left subclavian vein
Right subclavian vein
Either femoral vein (Fluoroscopy required)
Left IJ is possible but very difficult

Seldinger technique for percutaneous vascular access
General steps
•Trendelenberg position or leg elevation can
facilitate access to IJ and subclavian veins
•Sterile Field
•Anesthetize skin with lidocaine
•Access vein with Cook needle
•Insert guidewire
•Remove needle
•Consider making a skin nick with scalpel
•Insert 6-8F introducer sheath with dilator over
guidewire
•Remove dilator and guidewire
•Flush sheath using side port
•Advance temporary pacemaker to right
ventricle
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