Pacemaker implantation
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Pacemaker Implantation. Pacemaker Implantation. Pre-implantation Clinical assessment of patient Age Symptons Underlying cardiac rhythm Underlying medical state Size Evaluation of daily living activities Future needs. Pacemaker Implantation. Temporary pacing Access - Subclavian

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Pacemaker Implantation

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Pacemaker implantation

Pacemaker Implantation


Pacemaker implantation1

Pacemaker Implantation

  • Pre-implantation

    • Clinical assessment of patient

    • Age

    • Symptons

    • Underlying cardiac rhythm

    • Underlying medical state

    • Size

    • Evaluation of daily living activities

    • Future needs


Pacemaker implantation2

Pacemaker Implantation

  • Temporary pacing

    • Access - Subclavian

      - External / Internal jugulars

      - Femoral

      - Brachial

      - Surgical (epicardial)

    • Emergency Pacing- Oesophageal

      - Transthoracic

      - Transcutaneous


Pacemaker implantation3

Pacemaker Implantation

  • Permanent pacing

    • Access- Subclavian

      - Cephalic

    • Lead / Implantable Pulse Generator (IPG) placement site

      • Dominant side / patient activities

      • Anatomy / venous access

      • ? Previous intervention / infection

      • Concommitent therapy ... surgery / ICD

      • Experience of operator


Access blood vessels

SubclavianArtery

External Jugular

SubclavianVein

Internal Jugular

CephalicVein

Aorta

SuperiorVena Cava

PulmonaryArtery

InferiorVena Cava

Diaphragm

Lung

Access - Blood Vessels

1 - Anatomy 5


Access cardiac chambers

Left Atrium

Pulmonary Valve

Mitral Valve

Aortic Valve

Right Atrium

Tricuspid Valve

Left Ventricle

Right Ventricle

Access - Cardiac Chambers

1 - Anatomy 6


Pacemaker implantation

Pacemaker Implantation

  • Implantation analysis

    • 3 lead ECG monitor / recorder

      • chest lead - unipolar Electrogram (EGM)

      • Electrophysiology amp - bipolar EGM

    • Pacing system analyzer (PSA)

    • Documentation

      • patient demographics

      • medical history

      • IPG data

      • other implant data

Cont/.....


Pacemaker implantation

Pacemaker Implantation

  • Implantation analysis cont/.....

    • Sterile connector cables

    • IPG programmer + software

    • Magnet

    • Sterile accessories

    • Spare batteries, connectors etc.


Pacemaker implantation

Signal

Pacemaker Implantation

Signal Amplitude / Slew Rate


Pacemaker implantation

Pacemaker Implantation

Signal Frequency


Pacemaker implantation

Pacemaker Implantation

  • Measurements

    • 1.Sensing threshold

      • Amplitude (Minimum : “P” - 2mV , “R” - 5mV)

      • Slew rate

      • Frequency content

      • Duration

Cont/.....


Pacemaker implantation

Pacemaker Implantation

  • Measurements

    • 2.Pacing threshold

      • (Measured amplitude at various pulse widths)

      • Paced rate > = 20 ppm above spontaneous rate

      • Decrement variable output : Threshold < 1V @ 0.5ms

      • Impedance measurement : 300 - 1000 ohms

        .... calculated / displayed

      • Intracardiac electrogram

        .... PSA

        .... ECG machine

        .... Monitoring system

Cont/.....


Pacemaker implantation

Pacemaker Implantation

  • Measurements

    • 3.Lead stability

      • 1V output, or 2X diastolic threshold (min. 1V)

      • 10V output for diaphragm stimulation test

      • Lead sutured in position

      • Re-measure sensing / pacing characteristics

      • Dual-chamber system

        - Measure Retrograde Conduction Time

        - Adjust PSA mode

      • Interrogate / Optimise IPG

      • Confirm labelling information

Cont/.....


Pacemaker implantation

Pacemaker Implantation

  • Measurements

    • 4.Lead Connection

      • Lead attached to IPG, setscrew tightened and sealed with cap

      • IPG inserted

      • Ascertain correct sensing / pacing function of system. Apply magnet if required.

      • Complete all documentation

        - pacemaker clinic / hospital records

        - manufacturer’s file / central database


Implant workshop

Implant Workshop


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