BASIC CONCEPT OF PACEMAKER PUNEET KAPOOR EIC (101155005)

BASIC CONCEPT OF PACEMAKER

Over view - Pacemaker System - Pacemaker Function(slide 35) - Generic code for identification and description of pacemaker function (in other ppt slide no. 44 45 46) - Lead Impedance

BASIC CONCEPT OF PACEMAKER

Over view - Pacemaker System

WHAT IS A PACEMAKER ?
A device for increaseing a slow HR A device used primarily to correct some types of bradycardia, or slow heart rhythms.

WHO NEED IT ?

Indications for Pacing

Sick

Sinus Syndrome Bradycardia Heart Block

HOW DOES IT WORK ?

Attach the pacemaker system

Pulse

generator Sensing and Pacing leads

Make it into a circuit

Put

the system into the body / under the skin and join to the heart by pacing wire

Program its function by the programmer

THE PACEMAKER SYSTEM

Patient Lead Pacemaker Programmer

Lead

Pacemaker

LEADS

Epicardial Endocardial

LEAD SYSTEM

A lead is the insulated wire used to connect the pulse generator to the cardiac tissue The lead transmits the energy to the myocardium and relays intrinsic cardiac signals back to the sensing circuit

COMPONENTS OF A PACING LEAD

Suture Sleeve

Connector

Lead Body
Proximal Ring Electrode
Active Fixation Mechanism

Distal Tip Electrode

TYPES OF PACEMAKER CIRCUIT Unipolar VS Bipolar

UNIPOLAR VS. BIPOLAR

Unipolar

Bipolar

UNIPOLAR CONFIGURATION :

BIPOLAR CONFIGURATION:

UNIPOLAR

Lead

Pacemaker

BIPOLAR CONFIGURATION

Lead

Pacemaker

VENTRICULAR LEAD PLACEMENT

ATRIAL ENDOCARDIAL PLACEMENT

BASIC CONCEPT OF PACEMAKER

Over view - Pacemaker System - Pacemaker Function

SINGLE CHAMBER PACING

One Lead One Circuit / Pacemaker One Patient

DUAL-CHAMBER PACING

SENSING
Definition: The ability of the pacemaker to sense an intrinsic electrical signal

SENSING

Sensing
When programming sensitivity, as you lower the number you make the pacemaker more sensitive, (allow it see more).

5 mV 2 mV 1 mV

SENSING

Sensing

Sensing Threshold: indicates the minimum intracardiac signal that will be sensed by the pacemaker to initiate the pacemaker response (inhibited or triggered)

SENSING
8 mV 6 mV 4 mV 2 mV 0 mV

Sensing

Pacemaker programmed to 4 mV

R-wave 7 mV

R-wave 3 mV

SENSING
8 mV 6 mV 4 mV 2 mV 0 mV

Sensing

Pacemaker programmed to 2 mV

R-wave 7 mV

R-wave 3 mV

UNDERSENSING
Intrinsic Refractory Period

Automatic Interval
800 ms

Undersensing

Capture Capture Capture

Capture

OVERSENSING
Lack of Pacing Spike Automatic Interval Lack of Pacing Spike

Capture

Capture

Capture

Capture

OVERSENSING
Lack of Pacing Spike Lack of Pacing Spike

Sources
Myopotentials Environment Intrinsic Cardiac Signals

PACEMAKER CONFIGURATIONS VVI

PACEMAKER CONFIGURATIONS AAI

Indications Sick sinus syndrome in the absence of AV node disease or atrial fibrillation.

PACEMAKER CONFIGURATIONS DDD

PACEMAKER ECG
Should be LBBB . pacing from right ventricle Should be superior axis . pacing from apex Pacing spike may be seen

Heart rate must faster than the lower rate

DDDR PACING

Example of Dual-Chamber

BASIC CONCEPT OF PACEMAKER

Over view - Pacemaker System - Pacemaker Function - NBG Code - Lead Impedance

LEAD IMPEDANCE

Assessment of lead integrity Not lead position

LEAD RESISTANCE/IMPEDANCE CHANGES

High Resistance
>

2500 ohms Also called an Open Circuit Chronic lead system

Fractured

lead conductor coil

Acute

lead system

Loss

of contact between the terminal pin of the lead and the pacemaker header set screw

LEAD RESISTANCE/IMPEDANCE CHANGES

Lead Resistance/Impedance Changes

Low Resistance
<

250 ohms Also called Shorted Circuit Insulation Break-Down

Insulation

cut by suture Degradation of the insulation Subclavian Crush Syndrome