![• SENSING FUNCTION:
• Cardiac pacemaker have the ability to see
intrinsic cardiac Activity when it occurs.
• CAPTURE FUNCTION:
• The ability to generate a response from the
heart [contraction] after electrical stimulation
is referred as capture.](https://image.slidesharecdn.com/seminar2pacemaker-200415055330/85/Pacemaker-5-320.jpg)
![Patient education
• Check pulse daily.
• Avoid weight lifting.[>20 lb]
• Avoid shower.
• Avoid lifting hand over shoulder level.
• Wear loose-fitting clothing.
• Avoid trauma to the area.
• Come for regular check up](https://image.slidesharecdn.com/seminar2pacemaker-200415055330/85/Pacemaker-41-320.jpg)
Pacemaker
- 1. Prepared by Ms Theertha P Krishna 1st Year MSc Nursing MIMSCON pacemaker
- 2. Definition • An electronic device used to pace the heart when the normal conduction pathway is damaged or diseased. • A cardiac pacemaker is an electronic device, that delivers, direct electrical stimulation to stimulate the myocardium to depolarize, initiating a mechanical contraction.
- 3. Function of pacemaker • Pacing function • Sensing function • Capture function
- 4. Pacing function: • It is the ability of the pacemaker to stimulate either the atrium, Ventricle, or both chambers in sequence and initiate electrical depolarization and cardiac contraction. • Atrial pacing • Ventricular pacing • Atrio-ventricular pacing.
- 5. • SENSING FUNCTION: • Cardiac pacemaker have the ability to see intrinsic cardiac Activity when it occurs. • CAPTURE FUNCTION: • The ability to generate a response from the heart [contraction] after electrical stimulation is referred as capture.
- 6. Types of pacemaker • Permanent pacemaker • Temporary pacemaker Transvenous pacing Epicardial pacing Transcutaneous pacing
- 7. Permanent pacemaker • It is implanted totally with in the body. The power source is implanted subcutaneously usually over the pectoral muscle on the patients non dominant side. The pacing leads are threaded transvenously to the chamber to be paced.
- 8. Pace maker modes • Fixed rate: fire constantly at a preset rate with out regard to the electrical activity of the patient’s heart • Demand: it detects the hearts electrical activity. Fires only when the electrical activity of heart drops below the pre set rate.
- 9. Temporary pacemaker It has the power source outside the body • Types: • Transvenous pacemaker Leads are threaded transvenously to the chambers and attached to the power source • Epicardial pacing The pacing leads are attached to the epicardium during heart surgery • Transcutaneous pacemaker Noninvasive, power source is attached to large electrodes placed over the anterior and posterior chest
- 11. METHODS OF PLACEMENT OF A TEMPORARY PACEMAKER: • Transvenous pacemakers: • Inserted transvenously( usually subclavian, internal jugular, antecubital or femoral), into the right ventricle( or right atrium) and right ventricle for dualchamber pacing. And then attached to an external pulse generator. • Procedure done bedside or under fluroscopy.
- 13. Epicardiac pacemakers • In this case, the wires are attached to the endocardium, and are brought out through a surgical incision in the thorax. • These wires are connected to an external pulse generator. • Commonly seen after cardiac surgery.
- 15. TRANSCUTANEOUS PACING: • Non- invasive, multifunctional, electrode pads are placed. • Placement: anterior- posteriorly, anterior- laterally • Multifunctional electrode pads are then connected to an • External source( defibrillator with pacing ability). • The external impulse flows through the electrode pads and subcutaneous skin to the heart. • Thus pacing the heart.
- 16. Biventricular pacemakers • Also known as cardiac resynchronization. • Used to treat moderate to severe heart failure as a result of left ventricular dyssynchrony. • Intraventricular conduction defects result in an uncordinated contraction of the left and right ventricle, which causes a wide qrs complex and is associated with worsening heart failure and mortality. • Biventricular pacemakers can incorporate implantable cardio-verter defibrillators or can be used alone.
- 18. Parts of a pacemaker device:
- 20. Pulse generator • It consists of a circuitry and batteries. • In a PPI , it is encapsulated in a metal box, embedded under the skin. • The box protects the generator from electromagnetic interference and trauma. • PPI use lithium batteries. Life span= 8-12 yrs. • In a TPM, the generator is a small box with dials for programming. Transcutaneous pacing systems, use external source like defibrillator with pacing activity. • TPM use batteries which need replacement as per the use of the device. • Transcutaneous systems use rechargeable battery circuitry.
- 21. Pacemaker lead • Transmits electrical signal/ current from the pulse generator to the heart.
- 22. Pacemaker lead:
- 23. Types of pacemaker leads • Single chamber pacemaker: • 1 lead, either in atrial or ventricular chamber. • Sensing and pacing functions are confined to the chamber where the lead is placed.
- 25. Dual- chamber pacemaker • 2 leads • One lead in atrium, other in ventricle. • Pacing and sensing occur in both heart chambers, mimicking the physiological pacing.
- 27. Biventricular pacemaker • 3 leads- one lead in right atrium, one lead in right ventricle and one lead in left ventricle
- 29. Pacemaker codes • Letter 1: chamber that is paced (A=atria, V=ventricles, D=dual chamber) • Letter 2: chamber that is sensed (A=atria, V=ventricles, D=dual chamber, 0=none) • Letter 3: response to a sensed event (T=triggered, I=inhibited, D=dual - T and I, R=reverse)
- 30. Pacemaker codes • Letter 4: rate responsive features; an activity sensor, e.g. an accelerometer in the pulse generator, in single or dual chamber pacemakers detects bodily movement and increases the pacing rate according to a programmable algorithm (R=rate responsive pacemaker). • Letter 5: Anti-tachycardia facilities.
- 31. Indications for pacing • Indications for a temporary pacemaker: • Emergency/acute: 1)Acute myocardial infarction with: Asystole Symptomatic bradycardia Bilateral bundle branch block Mobitz type II second degree AV block
- 32. 2)Bradycardia not associated with acute myocardial infarction: Asystole 2nd or 3rd degree AV block Ventricular tachyarrhythmias
- 33. 3)Suppression of drug-resistant ventricular tachyarrhythmia or supraventricular tachycardia 4)Drug overdose, e.g. digoxin, b-blockers, verapamil
- 34. Elective 1)Support for procedures that may promote bradycardia • 2)General anaesthesia with: • 2nd or 3rd degree AV block • Intermittent AV block • 1st degree AV block with bifascicular block • 1st degree AV block and LBBB
- 35. 3)Cardiac surgery: • Aortic surgery • Tricuspid surgery • Ventricular septal defect closure • Ostium primum repair
- 36. Indications for a permanent pacemaker • Persisting symptomatic bradycardia • Complete AV block • Prevention of atrial fibrillation. • Dilated cardiomyopathy or hypertrophic obstructive cardiomyopathy
- 37. Pacemaker complications • Failure to output • Failure to capture • Oversensing • Undersensing • Pacemaker tachycardia • Pacemaker syndrome • Twiddler's syndrome
- 38. Operative failures: • Pneumothorax • Pericarditis • Infection • Haemothorax • Air embolism • Erosion of the pacer through the skin • Haematomas • Lead dislodgment • Venous thrombosis
- 39. Nursing care • Continuous ECG monitoring of heart rate & rhythm. • Monitor vital signs for every 15 minutes. • Monitor urine output. • Observe for the presence of dysarrhythmia. • Avoid injury . • Post insertion chest x-ray. • Monitor signs &symptoms of haemothorax & pneumothorax. • Evaluate continuously for evidence of bleeding.
- 40. • Monitor for evidence of lead migration. • Auscultate for pericardial friction rub. • Provide an electrically safe environment. • Prevent infection. • Relieve anxiety.
- 41. Patient education • Check pulse daily. • Avoid weight lifting.[>20 lb] • Avoid shower. • Avoid lifting hand over shoulder level. • Wear loose-fitting clothing. • Avoid trauma to the area. • Come for regular check up
- 42. • Avoid close exposure to magnetic force, radiation, metal detector etc • Carry all time pacemaker identity card • All electronic equipments should be grounded and repaired