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Basic Pacing Concepts Part I. Objectives. Identify the components of pacing systems and their respective functions Define basic electrical terminology Describe the relationship of amplitude and pulse width defined in the strength duration curve Explain the importance of sensing

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Presentation Transcript
objectives
Objectives
  • Identify the components of pacing systems and their respective functions
  • Define basic electrical terminology
  • Describe the relationship of amplitude and pulse width defined in the strength duration curve
  • Explain the importance of sensing
  • Discuss sources of electromagnetic interference (EMI) and patient/clinician guidelines related to these sources
  • Understand the need for and types of sensors used in rate responsive pacing
the heart has an intrinsic pacemaker
The Heart Has an Intrinsic Pacemaker
  • The heart generates electrical impulses that travel along a specialized conduction pathway
  • This conduction process makes it possible for the heart to pump blood efficiently
during conduction an impulse begins in the sinoatrial sa node and causes the atria to contract
During Conduction, an Impulse Begins in the Sinoatrial (SA) Node and Causes the Atria to Contract

Atria

Sinoatrial (SA) Node

Ventricles

Atrioventricular (AV) Node

slide6
Then, the Impulse Moves to the Atrioventricular (AV) Node and Down the Bundle Branches, Which Causes the Ventricles to Contract

Atria

SA node

Ventricles

AV node

Bundle branches

diseased heart tissue may
Diseased Heart Tissue May:
  • Prevent impulse generation in the SA node
  • Inhibit impulse conduction

SA node

AV node

implantable pacemaker systems contain the following components
Implantable Pacemaker Systems Contain the Following Components:

Lead wire(s)

Implantable pulse generator (IPG)

pacemaker components combine with body tissue to form a complete circuit
Pacemaker Components Combine with Body Tissue to Form a Complete Circuit
  • Pulse generator: power source or battery
  • Leads or wires
  • Cathode (negative electrode)
  • Anode (positive electrode)
  • Body tissue

Lead

IPG

Anode

Cathode

the pulse generator
The Pulse Generator:
  • Contains a battery that provides the energy for sending electrical impulses to the heart
  • Houses the circuitry that controls pacemaker operations

Circuitry

Battery

leads are insulated wires that
Leads Are Insulated Wires That:
  • Deliver electrical impulses from the pulse generator to the heart
  • Sense cardiac depolarization

Lead

types of leads
Types of Leads
  • Endocardial or transvenous leads
  • Myocardial/Epicardial leads
transvenous leads have different fixation mechanisms
Transvenous Leads Have Different “Fixation” Mechanisms
  • Passive fixation
    • The tines become lodged in the trabeculae(fibrous meshwork) of the heart
transvenous leads
Transvenous Leads
  • Active Fixation
    • The helix (or screw) extends into the endocardial tissue
    • Allows for lead positioning anywhere in the heart’s chamber
myocardial and epicardial leads
Myocardial and Epicardial Leads
  • Leads applied directly to the heart
    • Fixation mechanisms include:
      • Epicardial stab-in
      • Myocardial screw-in
      • Suture-on
cathode
Cathode
  • An electrode that is in contact with the heart tissue
  • Negatively charged when electrical current is flowing

Cathode

anode
Anode
  • An electrode that receives the electrical impulse after depolarization of cardiac tissue
  • Positively charged when electrical current is flowing

Anode

conduction pathways
Conduction Pathways
  • Body tissues and fluids are part of the conduction pathway between the anode and cathode

Anode

Tissue

Cathode

during pacing the impulse
During Pacing, the Impulse:

Impulse onset

  • Begins in the pulse generator
  • Flows through the lead and the cathode (–)
  • Stimulates the heart
  • Returns to the anode (+)

*

slide20
A Unipolar Pacing System Contains a Lead with Only One Electrode Within the Heart; In This System, the Impulse:
  • Flows through the tip electrode (cathode)
  • Stimulates the heart
  • Returns through body fluid and tissue to the IPG (anode)

+

Anode

-

Cathode

slide21
A Bipolar Pacing System Contains a Lead with Two Electrodes Within the Heart. In This System, the Impulse:
  • Flows through the tip electrode located at the end of the lead wire
  • Stimulates the heart
  • Returns to the ring electrode above the lead tip

Anode

Cathode

unipolar leads
Unipolar leads
  • Unipolar leads may have a smaller diameter lead body than bipolar leads
  • Unipolar leads usually exhibit larger pacing artifacts on the surface ECG
bipolar leads
Bipolar leads
  • Bipolar leads are less susceptible to oversensing noncardiac signals (myopotentials and EMI)

Coaxial Lead Design

advantages of silicone insulated leads
Advantages of Silicone-Insulated Leads
  • Inert
  • Biocompatible
  • Biostable
  • Repairable with medical adhesive
  • Historically very reliable
advantages of polyurethane insulated leads
Advantages ofPolyurethane-Insulated Leads
  • Biocompatible
  • High tear strength
  • Low friction coefficient
  • Smaller lead diameter
single chamber system
Single-Chamber System
  • The pacing lead is implanted in the atrium or ventricle, depending on the chamber to be paced and sensed
advantages and disadvantages of single chamber pacing systems
Implantation of a single lead

Single ventricular lead does not provide AV synchrony

Single atrial lead does not provide ventricular backup if A-to-V conduction is lost

Advantages and Disadvantages of Single-Chamber Pacing Systems

Advantages

Disadvantages

dual chamber systems have two leads
Dual-Chamber Systems Have Two Leads:
  • One lead implanted in the atrium
  • One lead implanted in the ventricle
most pacemakers perform four functions
Most Pacemakers Perform Four Functions:
  • Stimulate cardiac depolarization
  • Sense intrinsic cardiac function
  • Respond to increased metabolic demand by providing rate responsive pacing
  • Provide diagnostic information stored by the pacemaker
slide40

General Medtronic Pacemaker Disclaimer

INDICATIONS

Medtronic pacemakers are indicated for rate adaptive pacing in patients who may benefit from increased pacing rates concurrent with increases in activity (Thera, Thera-i, Prodigy, Preva and Medtronic.Kappa 700 Series) or increases in activity and/or minute ventilation (Medtronic.Kappa 400 Series).

Medtronic pacemakers are also indicated for dual chamber and atrial tracking modes in patients who may benefit from maintenance of AV synchrony. Dual chamber modes are specifically indicated for treatment of conduction disorders that require restoration of both rate and AV synchrony, which include various degrees of AV block to maintain the atrial contribution to cardiac output and VVI intolerance (e.g., pacemaker syndrome) in the presence of persistent sinus rhythm.

9790 Programmer

The Medtronic 9790 Programmers are portable, microprocessor based instruments used to program Medtronic implantable devices.

9462

The Model 9462 Remote Assistant™ is intended for use in combination with a Medtronic implantable pacemaker with Remote Assistant diagnostic capabilities.

CONTRAINDICATIONS

Medtronic pacemakers are contraindicated for the following applications:

·       Dual chamber atrial pacing in patients with chronic refractory atrial tachyarrhythmias.

·       Asynchronous pacing in the presence (or likelihood) of competitive paced and intrinsic rhythms.

·       Unipolar pacing for patients with an implanted cardioverter-defibrillator because it may cause unwanted delivery or inhibition of ICD therapy.

·       Medtronic.Kappa 400 Series pacemakers are contraindicated for use with epicardial leads and with abdominal implantation.

WARNINGS/PRECAUTIONS

Pacemaker patients should avoid sources of magnetic resonance imaging, diathermy, high sources of radiation, electrosurgical cautery, external defibrillation, lithotripsy, and radiofrequency ablation to avoid electrical reset of the device, inappropriate sensing and/or therapy.

9462

Operation of the Model 9462 Remote Assistant™ Cardiac Monitor near sources of electromagnetic interference, such as cellular phones, computer monitors, etc. may adversely affect the performance of this device.

See the appropriate technical manual for detailed information regarding indications, contraindications, warnings, and precautions.

 Caution: Federal law (U.S.A.) restricts this device to sale by or on the order of a physician.

slide41

Medtronic Leads

For Indications, Contraindications, Warnings, and Precautions for Medtronic Leads, please refer to the appropriate Leads Technical Manual or call your local Medtronic Representative.

Caution: Federal law restricts this device to sale by or on the order of a Physician.

Note:

This presentation is provided for general educational purposes only and should not be considered the exclusive source for this type of information. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in a particular situation.