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PACEMAKER

Yoga Yuniadi
Program Studi D3 Teknik Kardiovaskuler
Harapan Kita - UHAMKA
Overview
battery-powered implantable devices
that function to electrically stimulate
the heart
consist of a pager-sized housing
device which contains a battery and
the electronic circuitry that runs the
pacemaker, and one or two long thin
wires that travel through a vein in the
chest to the heart
Pacemaker System
Pulse generator
Titanium
Lithium battery
Electronic circuit
Lead
Connect the PG to myocardium
Tip electrode and insulated wire conductor
Bipolar or Unipolar
Steroid eluting
Pulse Generator and leads
Basic Fuction
To pace the heart in the absence of intrinsic impulses and to
sense intrinsic cardiac electrical activity if present and
inhibit pacing
Mode of programmed operation
Initials of mode letters:
The first letter refers to the chamber(s) being paced (Atrium,
Ventricle, or both, labeled Dual)
The second letter refers to the chamber(s) being sensed or
monitored for intrinsic electrical activity.
The third letter refers to the response to a sensed event
(Inhibit pacing output, Triggered pacing after a sensed event,
or Dual response)
The fourth letter represents the presence of rate
responsiveness (R)
The fifth letter represents special program availability (P)
Indications for Implantation
Sinus Node Dysfunction
Symptoms, regardless of the type of SND,
justify implantation of a pacemaker
SND + symptom = SSS
Indication of Implantation
Heart Block
1st degree AVB : pseudopacemaker syndrome,
as the prolonged PR interval creates an
alteration in atrial and ventricular timing and
synchronization
2nd degree AVB: Even in the absence of
symptoms, Mobitz II or those located below the
His bundle are typically treated with pacemaker
implantation because of the potential for
complete loss of conduction to the ventricles
3rd degree AVB = TAVB = CHB
Bifasicular or Trifasicular Block
Total AV Block
Indication of Implantation
neurocardiogenic syncope
hypertrophic obstructive
cardiomyopathy
congestive heart failure and wide QRS
Complications
4 5%
Venous Access
Pneumothorax
Hemothorax
Lead manipulation
Perforasi => tamponade
Arrhythmias
Pocket related
Hematoma
Infection (< 1%)
Skin erosion
Cardiac Tamponade due to
perforation
Troubleshooting PPM Problems
Inappropriate Sensing
Under sensing
Oversensing
Loss of Capture
Loss of Biventricular Capture
Intermittent under-sensing of
ventricular impulse
Ventricular pacing is inhibited because of
oversensing of myopotentials from diaphragm
resulting in asystole
Intermittent loss of capture due to
microdislodgement in the early postoperative
period
12-lead EKG biventri-cular capture.
RV pacing
A sensed and V paced
A pacing V sensing
Prosedur Implantasi PPM