Pacemaker ecg

Pacemaker ecg

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  Pacemaker ECG Chairperson : Assoc.Prof.Dr.Md.AbuSalim Presenter Dr.Md.Sajjad Safi MD-Cardiology, Phase-B Dept.of Cardiology UCC,BSMMU
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  Aims Pacemaker ECGinterpretations • To ascertain the pacing mode. • To determine whether the pacing operation is normal or abnormal. • To define the abnormality if present. • To differentiate pacing system malfunction from pseudo-malfunction. • To recognize the presence of an apparent ECG abnormality occurring due to normal operation of a complex pacemaker algorithm.
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  Types of Pacemakers •Atrial • Ventricular • Dual chamber
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  Pacemaker Electrodes • Thereare two types of pacemaker electrodes: • Bipolar –stimulating electrode (cathode ‘+’ ) at tip • Unipolar-negative electrode (anode ‘-’) just below the tip(10mm)
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  Pacemaker Identification System
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  Pacemaker artifact
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  Sensing and PacingFunctions • Fixed rate pacemakers: • Demand pacemakers:
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  Fixed rate pacemakers
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  Demand pacemakers:
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  Ventricular Pacemakers • Thereare three possible single chamber ventricular pacemaker modes: • V00 • VVI • VVT
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  V00 mode:
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  VVI mode:
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  Hysteresis
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  Effect of magnet:
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  Atrial Pacemakers • A00mode: • AAI mode: • AAT mode:
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  A00 mode:
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  AAI mode:
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  AAT mode:
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  Location of pacemakerelectrode
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  Left ventricular pacing
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  Pacemaker Syndrome
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  Dual Chamber Pacemakers •The different ECG patterns associated with a dual chamber pacemaker : ■ Atrial pacing in combination with ventricular pacing (AP,VP) ■ Atrial pacing in combination with ventricular sensing (AP,VS) ■ Atrial sensing in combination with ventricular pacing (AS,VP) ■ Atrial sensing in combination with ventricular sensing (AS,VS)
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  DDD Pacing: APand VP
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  DDD Pacing: APand VS
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  DDD Pacing: ASand VP
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  DDD Pacing: ASand VS
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  Pacemaker-Mediated Tachycardia
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  ECG Pattern ofOther Dual Chamber Pacemakers • The ECG of other, less commonly encountered dual chamber pacemakers are : • VAT mode: • DVI Pacing: • VDD mode:
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  VAT mode
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  DVI mode
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  VDD mode
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  Pacemaker with Antitachycardia Properties
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  Take home message •Pacing mode. • Normal or abnormal pacing. • Define and find out the cause of abnormal pacing. • Differentiate between malfunction and pseudo-malfunction. • Prompt action to be taken before hand.
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  References : • Basicand bedside electrocardiography: Romulo F.Baltazar • An introduction to electrocardiography: Leo Schamroth • Hurst’s the Heart,14th Edition • Manual of cardiovascular medicine,4th edition: Brain P.Griffin • Internet browser
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  THANK YOU