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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 ?
the system into the body / under the skin and join to the heart by pacing wire
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
Connector
Lead Body
Proximal Ring Electrode
Active Fixation Mechanism
Unipolar
Bipolar
UNIPOLAR CONFIGURATION :
BIPOLAR CONFIGURATION:
UNIPOLAR
Lead
Pacemaker
BIPOLAR CONFIGURATION
Lead
Pacemaker
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
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
Indications Sick sinus syndrome in the absence of AV node disease or atrial fibrillation.
PACEMAKER ECG
Should be LBBB . pacing from right ventricle Should be superior axis . pacing from apex Pacing spike may be seen
DDDR PACING
Example of Dual-Chamber
LEAD IMPEDANCE
Acute
lead system
Loss
of contact between the terminal pin of the lead and the pacemaker header set screw
Low Resistance
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