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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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Presentation Transcript
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

slide7

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/.....

slide8

Pacemaker Implantation

  • Implantation analysis cont/.....
    • Sterile connector cables
    • IPG programmer + software
    • Magnet
    • Sterile accessories
    • Spare batteries, connectors etc.
slide9

Signal

Pacemaker Implantation

Signal Amplitude / Slew Rate

slide10

Pacemaker Implantation

Signal Frequency

slide11

Pacemaker Implantation

  • Measurements
    • 1.Sensing threshold
      • Amplitude (Minimum : “P” - 2mV , “R” - 5mV)
      • Slew rate
      • Frequency content
      • Duration

Cont/.....

slide12

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/.....

slide13

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/.....

slide14

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

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