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Cardiac Assist Devices
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Types
Pacemakers
AICDs
VADs
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History
First pacemaker implanted in 1958
First ICD implanted in 1980
Greater than 500000 patients in the !"p#p$lati#n have pacemakers
115000 implanted each year
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Pacemakers Today "in%le #r d$al cham&er
'$ltiple pr#%ramma&le (eat$res
Adaptive rate pacin% Pr#%ramma&le lead c#n(i%$rati#n
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Internal Cardiac
Defbrillators (ICD) Transven#$s leads '$ltipr#%ramma&le
Inc#rp#rate all capa&ilities #(c#ntemp#rary pacemakers
"t#ra%e capacity
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Temporary Pacing
Indications )#$tes * Transven#$s transc$tane#$ses#pha%eal
!nsta&le &radydysrhythmias Atri#ventric$lar heart &l#ck
!nsta&le tachydysrhythmias
+,ndp#int reached a(ter res#l$ti#n #( the
pr#&lem #r permanent pacemaker implantati#n
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Permanent Pacing
Indications Chr#nic AV-. Chr#nic .i(ascic$lar and Tri(ascic$lar .l#ck
AV-. a(ter Ac$te 'I
"in$s /#de Dys($ncti#n -ypersensitive Car#tid "in$s and /e$rally
'ediated "yndr#mes
'iscellane#$s Pacin% Indicati#ns
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Chronic AVHB ,specially i( sympt#matic
Pacemaker m#st c#mm#nly indicated (#r
Type 2
.l#ck #cc$rs 3ithin #r &el#3 the .$ndle #( -is
42 -eart .l#ck /# c#mm$nicati#n &et3een atria and ventricles
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Chronic Biascic!lar andTriascic!lar Block
Di((erentiati#n &et3een $ni &i and
tri(ascic$lar &l#ck
"ync#pe c#mm#n in patients 3ith
&i(ascic$lar &l#ck
Intermittent 42 heart &l#ck c#mm#n
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AVHB ater Ac!te "I Incidence #( hi%h %rade AV-. hi%her Indicati#ns (#r pacemaker related t#
intraventric$lar c#nd$cti#n de(ects rather
than sympt#ms Pr#%n#sis related t# etent #( heart
dama%e
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#in!s $ode Dys!nction "in$s &radycardia sin$s pa$se #r arrest #r
sin#atrial &l#ck chr#n#tr#pic inc#mpetence 6(ten ass#ciated 3ith par#ysmal "VTs
7&radycardiatachycardia syndr#me 'ay res$lt (r#m dr$% therapy "ympt#matic: 6(ten the primary indicati#n (#r a pacemaker
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Hypersensiti%e Carotid#in!s #yndrome
; "ync#pe #r presync#pe d$e t# an
ea%%erated resp#nse t# car#tid sin$s
stim$lati#n
; De(ined as asyst#le %reater than 4 sec d$e
t# sin$s arrest #r AV-. an a&r$pt
red$cti#n #( .P #r th
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$e!rally "ediated#yncope
10
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"iscellaneo!s -ypertr#phic 6&str$ctive Cardi#my#pathy Dilated cardi#my#pathy Cardiac transplantati#n Terminati#n and preventi#n #(
tachydysrhythmias Pacin% in children and ad#lescents
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Indications or ICDs Cardiac arrest d$e t# VT>VF n#t d$e t# a
transient #r reversi&le ca$se "p#ntane#$s s$stained VT
"ync#pe 3ith hem#dynamically si%ni(icants$stained VT #r VF /"VT 3ith CAD previ#$s 'I ?V dys($ncti#n and
ind$ci&le VF #r VT n#t s$ppressed &y a class 1antidysrhythmic
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De%ice #election Temp#rary pacin% 7invasive vs@
n#ninvasive
Permanent pacemaker
ICD
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Pacemaker Characteristics
; Adaptiverate pacemakers
;"in%lepass lead "ystems
; Pr#%ramma&le lead c#n(i%$rati#n
; A$t#matic '#de"3itchin%
; !nip#lar vs@ .ip#lar electr#de
c#n(i%$rati#n
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ICD selection Anti&radycardia pacin%
Antitachycardia pacin%
"ynchr#nied #r n#nsynchr#nied sh#cks
(#r dysrhythmias
'any #( the #ther #pti#ns inc#rp#rated
int# pacemakers
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Appr#aches t# Inserti#n
a@ IV appr#ach 7end#cardial lead
&@ "$&c#stal appr#ach 7epicardial #r
my#cardial lead
c@ /#ninvasive transc$tane#$s pacin%
Alternative t# emer%ency transven#$s pacin%
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'echanics
Pr#vide the rhythm heart cann#t pr#d$ce
,ither temp#rary #r permanent
C#nsists #( eternal #r internal p#3er
s#$rce and a lead t# carry the c$rrent t#
the heart m$scle
.atteries pr#vide the p#3er s#$rce
Pacin% lead is a c#iled 3ire sprin% encased insilic#ne t# ins$late it (r#m dy (l$ids
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!nip#lar Pacemaker
?ead has #nly #ne electr#de that c#ntactsthe heart at its tip 7B p#le
The p#3er s#$rce is the 7 p#le
Patient serves as the %r#$ndin% s#$rcePatients dy (l$ids pr#vide the ret$rn
path3ay (#r the electrical si%nal
,lectr#ma%netic inter(erence #cc$rs m#re#(ten in $nip#lar leads
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!nip#lar Pacemaker
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.ip#lar Pacemaker
I( &ip#lar there are t3# 3ires t# the heart #r
#ne 3ire 3ith t3# electr#des at its tip
Pr#vides a &$iltin %r#$nd lead
Circ$it is c#mpleted 3ithin the heart
Pr#vides m#re c#ntact 3ith the
end#cardi$m needs l#3er c$rrent t#
pace
?ess chance (#r ca$tery inter(erence
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.ip#lar Pacemaker
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Indicati#ns
1@ "ick sin$s syndr#me 7Tachy&radysyndr#me
@ "ympt#matic &radycardia
4@ Atrial (i&rillati#n
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Indications
E@ C#mplete heart &l#ck
@ "in$s arrest>&l#ck
8@ Tachyarrhythmias
"$praventric$lar ventric$lar
T# #verdrive the arrhythmia
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Atrial Fi&rillati#n
+ A (i&rillatin% atri$m cann#t &e paced
+ Place a VVI
+ Patient has n# atrial kick
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Types
1@ Asynchr#n#$s>Fied )ate
@ "ynchr#n#$s>Demand
4@ "in%le>D$al Cham&er"e$ential 7A H V
n#npr#%ramma&le
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Asynchr#n#$s>Fied )ate
D#es n#t synchr#nie 3ith intrinsic -)
!sed sa(ely in pts 3ith n# intrinsic
ventric$lar activity
I( pt has vent@ activity it may c#mpete
3ith pts #3n c#nd$cti#n system
VT may res$lt 7)#nT phen#men#n
, V66 A66 D66
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"ynchr#n#$s>Demand
C#ntains t3# circ$its + 6ne (#rms imp$lses
+ 6ne acts as a sens#r
Jhen activated &y an ) 3ave sensin% circ$iteither tri%%ers #r inhi&its the pacin%circ$it
Called KTri%%eredL #r KInhi&itedL pacers
'#st (re$ently $sed pacer
,liminates c#mpetiti#n
,ner%y sparin%
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,amples #( Demand Pacemakers
DDI
VVI>VVT
AAI>AAT
Disadvanta%e Pacemaker may &e (##led &y
inter(erence and may n#t (ire
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D$al Cham&er AV
"e$ential
Facilitates a n#rmal se$ence &et3een
atrial and ventric$lar c#ntracti#n
Pr#vides atrial kick B ventric$lar pacin%Atrial c#ntracti#n ass$res m#re c#mplete
ventric$lar (illin% than the ventric$lar
demand pacin% $nit
Increase C6 545= #ver ventric$lar pacin%
al#ne
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AV "e$ential
Disadvanta%e '#re di((ic$lt t# place
'#re epensive
C#ntraindicati#n Atrial (i&rillati#n "VT
Devel#ped d$e t# inade$acy #( Kp$re atrial
pacin%L
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"in%le Cham&er
Atrial
Ventric$lar
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KP$re Atrial Pacin%L
!sed 3hen "A n#de is diseased #rdama%ed &$t AV c#nd$cti#n system
remains intact
Pr#vides atrial kick
Atrial kick can add 1540= t# C6 #ver a
ventric$lar pacemaker
,lectr#de in atri$m stim$l$s pr#d$ces a
P 3ave
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Pr#&lems 3ith Atrial Pacin%
,lectr#de di((ic$lt t# sec$re in atri$m
Tends t# (l#at
Ina&ility t# achieve c#nsistent atrial
KdemandL ($ncti#n
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Ventric$lar Pacemakers
I( electr#de is placed in ri%ht ventricle
stim$l$s pr#d$ces a le(t ... pattern
I( electr#de is placed in le(t ventricle
stim$l$s pr#d$ces a ri%ht ... pattern
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Pr#%ramma&ility
Capacity t# n#ninvasively alter #ne #( severalaspects #( the ($ncti#n #( a pacer
Desira&le since pacer re$irements (#r a pers#n
chan%e #ver time
'#st c#mm#n pr#%rammed areas)ate
6$tp$t
AV delay in d$al cham&er pacers
) 3ave sensitivity
Advanta%e can #verc#me inter(erence
ca$sed &y electr#ca$tery
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4?etter #r 5?etter C#de
Devised t# simpli(y the namin% #(
pacemaker %enerat#rs
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First letter
Indicates the cham&er &ein% paced
A Atri$m
V Ventricle
D D$al 7.#th A and V
6 /#ne
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"ec#nd ?etter
Indicates the cham&er &ein% sensed
A Atri$m
V Ventricle
D D$al 7.#th A and V
6 Asynchr#n#$s #r d#es n#t apply
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Third ?etter
Indicates the %enerat#rs resp#nse t# a
sensed si%nal>) 3ave
I Inhi&ited
T Tri%%ered
D D$al 7T H I
6 Asynchr#n#$s> d#es n#t apply
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F#$rth ?etter
Indicates pr#%rammin% in(#rmati#n
6 /# pr#%rammin%
P Pr#%rammin% #nly (#r #$tp$t and>#r rate
' '$ltipr#%ramma&le
C C#mm$nicatin%
) )ate m#d$lati#n
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Fi(th ?etter
This letter indicates tachyarrhythmia
($ncti#ns
. .$rsts
/ /#rmal rate c#mpetiti#n
" "cannin%
, ,ternal
6 /#ne
Ta&le #( Pacer C#des
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Ta&le #( Pacer C#des
ypes # $ se enera #rs
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ypes # $ se enera #rs
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,amples
A66
A Atri$m is paced
6 /# cham&er is sensed
6 Asynchr#n#$s>d#es n#t applyV66
V Ventricle is paced
6 /# cham&er is sensed6 Asynchr#n#$s>d#es n#t apply
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,amples
VVI
V Ventricle is the paced cham&er
V Ventricle is the sensed cham&er
I Inhi&ited resp#nse t# a sensed
si%nal
Th$s a synchr#n#$s %enerat#r that paces
and senses in the ventricle
Inhi&ited i( a sin$s #r escape &eat #cc$rs
Called a KdemandL pacer
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,amples
DVI
D .#th atri$m and ventricle are
paced
V Ventricle is sensed
I )esp#nse is inhi&ited t# a sensed
ventric$lar si%nal
F#r AV se$ential pacin% in 3hich atria and
ventricles are paced@ I( a ventric$larsi%nal %enerat#r 3#nt (ire
6verridden &y intrinsic -) i( (aster
, l
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,amples
DDD
Greatest (lei&ility in pr#%rammin%.est appr#imates n#rmal cardiac resp#nse t# eercise
D66
'#st apparent p#tential (#r seri#$s ventric$lar
arrhythmias
VAT
Ventric$lar paced atrial sensed
"h#$ld have an atrial re(ract#ry peri#d pr#%rammed in
t# prevent risk #( arrhythmias ind$ced &y PACs(r#m ect#pic #r retr#%rade c#nd$cti#n
AV interval is $s$ally 15050 millisec#nds
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6ther In(#rmati#n
Demand pacer can &e m#mentarily c#nverted t#
asynchr#n#$s m#de &y placin% ma%net eternally
#ver p$lse %enerat#r in s#me pacers
D$al cham&er pacers pre(era&le (#r alm#st allpatients ecept th#se 3ith chr#nic atrial
(i&rillati#n 7need a 3#rkin% c#nd$cti#n system
Asynchr#n#$s pacer m#des n#t %enerally $sed
#$tside the 6)6) has m$ltiple p#tential s#$rces #( electrical inter(erence
3hich may prevent n#rmal ($ncti#n #( demand pacers
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6ther In(#rmati#n
VVI "tandard ventric$lar demandpacemaker
DVI AV pacemaker 3ith t3# pacin%
electr#desDemand pacer may &e #verridden &y
intrinsic -) i( m#re rapid
Demand pacer can &e m#mentarilyc#nverted t# asynchr#n#$s m#de &yplacin% ma%net eternally #ver p$lse%enerat#r
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"ensin%
A&ility #( device t# detect intrinsic cardiac
activity
!ndersensin% (ail$re t# sense
6versensin% t## sensitive t# activity
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!ndersensin% Fail$re t# sense
Pacer (ails t# detect an intrinsic rhythm
Paces $nnecessarily
Patient may (eel Ketra &eatsL
I( an $nneeded pacer spike (alls in the latter
p#rti#n #( T 3ave dan%er#$s
tachyarrhythmias #r V (i& may #cc$r 7)
#n TT Increase sensitivity #( pacer
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6versensin%
Pacer interprets n#ncardiac electricalsi%nals as #ri%inatin% in the heart
Detects etrane#$s si%nals s$ch as th#se
pr#d$ced &y electrical e$ipment #r theactivity #( skeletal m$scles 7tensin%(lein% #( chest m$scles "!
Inhi&its itsel( (r#m pacin% as it 3#$ld a tr$e
heart &eat
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6versensin%
6n ,CG pa$ses l#n%er than the n#rmal
pacin% interval are present
6(ten electrical arti(act is seenDeprived #( pacin% the patient s$((ers
C6 (eels diy>li%htheaded
'#st #(ten d$e t# sensitivity &ein%pr#%rammed t## hi%h
T )ed$ce sensitivity
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Capt$re
Dep#lariati#n #( atria and>#r ventricles in
resp#nse t# a pacin% stim$l$s
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/#ncapt$re>Fail$re t# Capt$re
Pacers electrical stim$l$s 7pacin% (ails t#dep#larie 7capt$re the heart
There is n# K(ail$re t# paceL
Pacin% is simply $ns$ccess($l at stim$latin% ac#ntracti#n
,CG sh#3s pacer spikes &$t n# cardiacresp#nse
C6 #cc$rs
T thresh#ld>#$tp$t stren%th #r d$rati#n
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Pacer Fail$re
A@ ,arly
electr#de displacement>&reaka%e
.@ Fail$re M E m#nths
Premat$re &attery depleti#n
Fa$lty p$lse %enerat#r
P ' l( ti ,CG
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Pacer 'al($ncti#ns per ,CG
Fail$re t# capt$re
Fail$re t# sense
)$na3ay pacemaker
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Pacer 'al($ncti#n "
1@ Verti%#>"ync#pe
+J#rsens 3ith eercise
@ !n$s$al (ati%$e
4@ ?#3 .>P> peripheral p$lses6rth#pnea
8@ Altered mental stat$s
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,OG ,val$ati#n
Capt$re "h#$ld &e 11
7spike,OG c#mple>p$lse
+/#t help($l i( patients -) is M
pacer rate i( synchr#n#$s type
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,OG ,val$ati#n
Pr#per ($ncti#n #( demand pacer
C#n(irmed &y seein% capt$red &eats #n ,OG
3hen pacer is c#nverted t# asynchr#n#$s
m#dePlace eternal c#nverter ma%net #ver %enerat#r
D# n#t $se ma%net $nless rec#mmended
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CAPT!),
6$tp$t amt #( c$rrent 7mAmps needed t#
%et an imp$lse
"ensitivity 7milliv#lts the l#3er the
settin% the m#re sensitive
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Anesthesia (#r Inserti#n'AC
T# pr#vide c#m(#rt
T# c#ntr#l dysrhythmias
T# check (#r pr#per ($ncti#n>capt$re
-ave eternal pacer>Is$prel>Atr#pineready
C#ntin$#$s ,CG and peripheral p$lse
P$lse # 3ith plethysm#%raphy t# seeper($si#n #( each c#mple
7,OG may &ec#me $nreada&le
Pacemaker Inserti#n
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Pacemaker Inserti#n
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Inter(erence
Thin%s 3hich may m#di(y pacer ($ncti#n
"ympath#mimetic amines may increasemy#cardial irrita&ility
$inidine>Pr#cainamide t#icity may ca$se(ail$re #( cardiac capt$re
OB advanced ht disease #r (i&r#sis ar#$ndelectr#de may ca$se (ail$re #( cardiaccapt$re
A th i ( Pt ith
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Anesthesia (#r Pt 3ith
Pacemakera@ C#ntin$#$s ,CG and peripheral p$lse
&@ P$lse # 3ith plethysm#%raphy t#
see per($si#n #( each c#mple
7,OG may &ec#me $nreada&le
c@ De(i&rillat#r>crash cart availa&le
d@ ,ternal pacer availa&le
e@ ,ternal c#nverter ma%net availa&le
Anesthesia (#r Pt 3ith Pacemaker
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Anesthesia (#r Pt 3ith Pacemaker
I( $sin% "$ccinylch#line c#nsider de(ascic$latin% d#se#( ')
Fascic$lati#ns may inhi&it (irin% d$e t# the skeletalm$scle c#ntracti#ns picked $p &y %enerat#r asintrinsic ) 3aves
Place %r#$nd pad (ar (r#m %enerat#r &$t cl#se t#ca$tery tip
C#ver pad 3ell 3ith c#nd$ctive %el
'inimies detecti#n #( ca$tery c$rrent &y p$lse
%enerat#rI( patient has a transven#$s pacemaker increased risk
#( V@ (i& (r#m micr#sh#ck levels #( electricalc$rrent
A th i ( Pt ith P k
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Anesthesia (#r Pt 3ith Pacemaker
Ca$tery may inter(ere 3ith pacer
'ay inhi&it tri%%erin% 7pacer may sense
electrical activity and n#t (ire
'ay inadvertently repr#%ram'ay ind$ce arrhythmias sec#ndary t# c$rrent
'ay ca$se (iedrate pacin%
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A$t#matic
Implanta&le
Cardiac
De(i&rillat#rs
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AICD
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Parts #( AICD
P$lse %enerat#r 3ith &atteries
and capacit#rs
,lectr#de #r lead system
"$r%ically placed in #r #n
pericardi$m>my#cardi$m
'#nit#rs -) and rhythm
Delivers sh#ck i( VT #r V(i&
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Placement #( AICD
Pulse Generator
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AICD Indicati#ns
)isk (#r s$dden cardiac death
ca$sed &y tachyarrhythmias 7VT V(i&
)ed$ces death (r#m
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De(i&rillat#r C#des
First letter "h#ck Cham&er
A atri$m
V ventricle
D d$al6 n#ne
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De(i&rillat#r C#des
"ec#nd letter Antitachycardia Cham&er
A atri$m
V ventricle
D d$al6 n#ne
Third letter Tachycardia Detecti#n
, ,OG- -em#dynamics
Defbrillator Codes
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Defbrillator Codes
F#$rth letter Anti&radycardia Pacin%
Cham&er
A atri$m
V ventricleD d$al
6 n#ne
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"ettin%s
Gives a sh#ck at 0@140 Q#$les
!s$ally 5 Q#$les
Takes 50 sec#nds t# sense VT>VF
Takes 515 sec#nds m#re t# char%e@510 sec#nd delay &e(#re net sh#ck is
administered
T#tal #( 5 sh#cks then pa$ses
I( patient is t#$ched may (eel a &$ #r tin%leI( CP) is needed 3ear r$&&er %l#ves (#r
ins$lati#n
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Tiered Therapy
A&ility #( an implanted cardi#verter
de(i&rillat#r t# deliver di((erent types #(
therapies in an attempt t# terminateventric$lar tachyarrhythmias
, #( therapies
Anticardiac pacin%
Cardi#versi#nDe(i&rillati#n
Anti&radycardia pacin%
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Anesthesia
'AC vs General
!s$ally %eneral d$e t# ind$cti#n #( VT>VF s#
AICD can &e checked (#r per(#rmance
?ead is placed in heartGenerat#r is placed in hip area #r in $pper
chest
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VADs
Ventric$lar assist devices
Implanta&le p$mps $sed (#r circ$lat#rys$pp#rt in pts 3ith C-F
.l##d (ills device thr#$%h a cann$lati#n sitein V #r A
Diaphra%m p$mps &l##d int# a#rta #r PA
"et at predetermined rate 7(ied #ra$t#matic 7rate chan%es in resp#nse t#ven#$s ret$rn
,lectr#ma%netic Inter(erence
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,lectr#ma%netic Inter(erence
#n Pacers and AICDs
,lectr#ca$tery
'ay inhi&it #r tri%%er #$tp$t'ay revert it t# asynchr#n#$s m#de
'ay repr#%ram inappr#priately
'ay ind$ce A(i& #r V(i&'ay &$rn at leadtiss$e inter(ace
,lectr#ma%netic Inter(erence #n
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,lectr#ma%netic Inter(erence #n
Pacers and AICDs
De(i&rillati#n
'ay ca$se permanent dama%e t# p$lse
%enerat#r
'ay &$rn at leadtiss$e inter(ace)adiati#n Therapy
'ay dama%e metal #ide silic#n circ$itry
'ay repr#%ram inappr#priately
,lectr#ma%netic Inter(erence
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,lectr#ma%netic Inter(erence
#n Pacers and AICDs
P,T>CT 7C#ntraindicated'ay dama%e metal #ide silic#n circ$itry
'ay repr#%ram inappr#priately
')I 7C#ntraindicated'ay physically m#ve p$lse %enerat#r'ay repr#%ram inappr#priately
'ay %ive inappr#priate sh#ck t# pt 3ith AICD
P/"s'ay ca$se inappr#priate sh#ck #r inhi&iti#n
Test at hi%hest #$tp$t settin%
Deactivatin% a Pacemaker
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Deactivatin% a Pacemaker
Deactivate t# prevent inappr#priate (irin% #rinhi&iti#n
Can &e deactivated &y a special
pr#%rammer>3and #r &y a ma%net placed
#ver %enerat#r (#r 40 sec#nds
P$t in asynchr#n#$s m#de #r place eternal
pacer #n patient
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I( Pt has a Pacemaker>AICD
/#t all m#dels (r#m a certain c#mpany&ehave the same 3ay 3ith ma%net
placement R
For all generators, call manufacturerMost reliable method for determining magnet
response ! !
C#din% Patient
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C#din% Patient
I( patient c#des d# n#t 3ait (#r AICDt# 3#rk
"tart CP) H de(i&rillate immediately
Pers#n %ivin% CP) may (eel sli%ht &$A 40Q#$le sh#ck is S Q #n pts skin
,ternal de(i&rillati#n 3ill n#t harm AICD
Chan%e paddle placement i( $ns$ccess($lattempt
Try AP paddle placement i( A?at$ns$ccess($l
Pts 3ith
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Pacemakers>AICDs>VADs
6&tain in(#rmati#n (r#m patient re%ardin%device
Ask h#3 #(ten patient is sh#cked>day
-i%h #r l#3 OB may render end#thelial cellsm#re #r less re(ract#ry t# pacin%
A pr#perly capt$rin% pacemaker sh#$ld als#
&e c#n(irmed &y 3atchin% the ,OG andpalpatin% the patients p$lse
Anesthetic C#nsiderati#ns
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Anesthetic C#nsiderati#ns
Av#id "$ccinylch#line
Oeep P/" as (ar (r#m %enerat#r as p#ssi&le
-ave &ack$p plan (#r device (ail$re
-ave meth#d #ther than ,OG (#r assessin%
circ$lati#n
-ave ma%net availa&le in 6)
,l t t !
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,lectr#ca$tery !se
Place %r#$ndin% pad as (ar (r#m %enerat#ras p#ssi&le
Place %r#$ndin% pad as near t# s$r%ical
(ield as p#ssi&le!se &ip#lar electr#ca$tery i( p#ssi&le
-ave s$r%e#n $se sh#rt &$rsts #(electr#ca$tery
7S1 sec 510 sec#nds apart
'aintain l#3est p#ssi&le c$rrent
,l t t !
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,lectr#ca$tery !se
I( ca$tery ca$ses asyst#le place ma%net#ver c#ntr#l $nit H chan%e (r#m
inhi&ited t# (ied m#de
Chan%e &ack a(ter3ards.e alert (#r ) #n T phen#men#n
P#st#perative C#nsiderati#ns
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P#st#perative C#nsiderati#ns
Av#id shiverin%
-ave device checked and repr#%rammed i(
$esti#ns arise a$t its ($ncti#n
, l ( )h th
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,amples #( )hythms
"ensin%Patients #3n &eat is sensed &y pacemaker s# d#es n#t (ire
, l ( )h th
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,amples #( )hythms
!ndersensin%Pacemaker d#esnt sense patients #3n &eat and
(ires 7sec#nd last &eat
, l ( )h th
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,amples #( )hythms
6versensin%
Pacemaker senses heart &eat even th#$%h it isnt &eatin%@/#te the l#n% pa$ses@
, l ( )h th
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,amples #( )hythms
Capt$re
Pacemaker #$tp$t 7spike is (#ll#3ed &y ventric$lar
p#lariati#n 73ide )"@
, l ( )h th
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,amples #( )hythms
/#ncapt$re
Pacer stim$l$s (ails t# ca$se my#cardial dep#lariati#n
Pacer spike is present &$t n# ,CG 3ave(#rm
Fires but fails to capture
Undersensing-
Fails to sense
ECG
Pacer spikes after theQRS
Oversensing-Fails to fire
, l ( )h th
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,amples #( )hythms
100 = Atrial Paced )hythm 3ith 100= Capt$re
, amples #( )h thms
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,amples #( )hythms
100= Ventric$lar Paced )hythm 3ith 100=Capt$re
,amples #( )hythms
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,amples #( )hythms
100= Atrial and 100= Ventric$lar Paced )hythm3ith 100= Capt$re
,amples #( )hythms
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,amples #( )hythms
50= Ventric$lar Paced )hythm 3ith 100= Capt$re
,amples #( )hythms
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,amples #( )hythms
5= Ventric$lar Paced )hythm 3ith 100= Capt$re7/#te the sensin% that #cc$rs@ Pacer sensesintrinsic -) and d#esnt (ire@
,amples #( )hythms
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,amples #( )hythms
AICD "h#ck #( VTC#nverted t# /")
,amples #( )hythms
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p y
,amples #( )hythms
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,amples #( )hythms
,amples #( )hythms
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,amples #( )hythms
DDD Pacemaker
)e(erences
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)e(erences
'#ser "A Cra3(#rd D Th#mas A@ AICDs@CC Nurse@ 1994E4@
/a%elha$t NN a%lanicny O?@ Nurse
Anesthesia. Philadelphia "a$nders@199@
6$ellette "@ 7000@ Anesthetic c#nsiderati#ns inpatients 3ith cardiac assist devices@ CNRA,237 90@
)#th N@ 7199