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Type Temporary Methods and Uses AICDs Nomenclature - Other Points
Home-Amb-Card-Crit-Neuro-OB-Orth-Pain-Ped-Reg-Tran-Vasc-Misc (from Tom VerLee's and Hugh Allen's sites and Mike Stella, MD)
Permanent Nomenclature - Magnets - Electrocautery - Preop - Intraop
Pacemakers: Nomenclature Pacers use a 5-letter code: first 3 letters most important 1. First Letter: Chamber Paced A= Atrium V= Ventricle D= Dual (A+V) 2. 2nd Letter: Chamber Sensed A= Atrium V= Ventricle D= Dual (A+V) O= None 3. 3rd Letter: Response after Sensing: I = Pacing Inhibited T= Pacing Triggered D= Dual (I+T) O= None 4. 4th Letter: Programmability P = Rate & Output M = Multiprogramable C = Communicating R = Rate adaptive O = None 5. 5th Letter: Arrhythmia Control P = pacing S= shock D= Dual (P+S) O = None Other Terms: Unipolar vs. Bipolar: Refers to electrode polarity. (Unipolar is more susceptible to malfunction secondary to interference.) Single vs. Dual leads: self-explanatory.
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atrium & ventricle both sensed.Pacemakers http://www. ventricle sensed. Call cardiologist to re-program pacemaker for surgery. Evaluation includes documentation in the chart of the following Identification of pacemaker manufacturer and model Assessment of battery status using magnet or telemetered data Documentation of telemetered data. Back to Top of Page Pacemakers: Electrocautery Potential effects of electrocautery Inhibition of a pacemaker Reprogramming of a pacemaker Resetting of a pacemaker to its “backup mode” Permanent damage to the pulse generator (rare) Induction of ventricular fibrillation: rarely energy can be picked up by the AICD/pacemaker and/or the leads and delivered directly to the heart. pacing triggered in each chamber if beat not sensed DDDR = AV concordance with physiologic response. Examples: VVI = Ventricle paced. A rise in the capture threshold by causing an endocardial burn at the electrode-myocardial interface. have Zoll external pacer outside the room. Back to Top of Page Pacemakers: Magnets In modern implantable pacers (>1990). If cardiologist unavailable and surgery emergent. impedance readings and capture thresholds Determination of appropriate pacing mode for surgery Reprogramming The following changes may be made at the time of the evaluation or on the day of surgery: 2 of 4 1/5/2013 10:24 PM . DDD = Atrium & ventricle can both be paced. Synchronous pacing: Asynchronous pacers are fixed-rate. This may lead to loss of capture (rare) Back to Top of Page Pacemakers: Preoperative Evaluation Ask Cardiology to evaluate/ re-program pacer for surgery. pacing inhibited if beat sensed.html Asynchronous vs. magnets DO NOT predictably convert the pacer to asynchronous mode. and do not sense atrial or ventricular myopotentials. VVIR = Demand ventricular pacing with physiologic response to exercise.edu/~rvp/old/RP_Anesthesia/Basics/Pacers.unc.
maintenance Arrest. intraoperative. Back to Top of Page Pacemakers: Intra-Operative Management No special anesthesia technique. ECT: requires asynchronous (non-sensing) mode Nerve Stimulator. Medtronic. Line: to detect mechanical systole (VF will not be seen on ECG during electrocautery) Electrocautery AVOID if possible Bipolar preferred (restricts the energy field to the areas around the cautery probe and minimizes its spread throughout the body).edu/~rvp/old/RP_Anesthesia/Basics/Pacers. use lead that shows pacer spikes to confirm that pacemaker is functioning appropriately Pulse Oximeter +/or Art. Special Situations: Lithotripsy: keep generator out of shockwave path. TENS: potential problems MRI: Absolute contraindication Back to Top of Page Temporary Pacing Techniques Method Transcutaneous Transesophageal Transvenous semirigid Chambers Paced Right Ventricle Left Atrium Uses Arrest. prophylactic. it will likely be turned off for surgery. EKG monitor disable filtering of pacer spikes. If monopolar necessary keep pacemaker generator out of path between cautery and "grounding" pad Use in short bursts to avoid long periods of asystole DO NOT use a magnet to convert the pace maker to a fixed asynchronous rate. Telectronics. then on postoperatively.Pacemakers http://www. overdriveSVT Atrium and/or Vent Arrest. Many pacemakers (including Pacesetters. who has pacer for obstructive or dilated cardiomyopathy ICDs should be programmed off just before surgery. Intraoperative and Prophylactic Prophylactic atrial.this will prevent inappropriate rapid pacing Probably needed for: Pacer-dependent patient Major chest or abdomen case Pt. particularly with thoracic surgery when chest wall movement occurs .unc.prophylactic. intraop.html Pacer will likely be turned to DOO or VOO during surgery if there is no competition from intrinsic or ectopic beats If pacer is rate response activated. and Cordis) will be predisposed to inappropriate reprogramming if a magnet is over the pacemaker during the application of eletrocautery. maintenance Transvenous flow-directed Right Ventricle 3 of 4 1/5/2013 10:24 PM .
Pacemakers can function in presence of ICD as long as electrodes are bipolar.unc. Newer devices can deliver “tiered therapy” (pacing. then increasing shocks) 2. Most ICDs have backup VVI pacing to protect against post shock bradycardia. Back to Top of Page 4 of 4 1/5/2013 10:24 PM . maintenance Ventricle Arrest only Automatic Implantable Cardioverter-Defibrillator AICDs: Nomenclature Position I Chamber(s) shocked O=None A=Atrium V=Ventricle D=Dual Back to Top of Page Position II Antitachicardia pacing chamber(s) O=None A=Atrium V=Ventricle D=Dual Position III Tachycardiadetection E=Electrogram H=Hemodynamic Position IV Antibradycardia pacing chamber(s) O=None A=Atrium V=Ventricle D=Dual AICDs: Additional points: 1. intraoperative. Devices measure R-R interval over time 3.Pacemakers http://www.html Pacing PAC Epicardial Transthoracic Back to Top of Page Atrium and/or Vent Arrest. 4. Magnet application in most newer models will suspend tachyarrhythmia detection. 5. This should be done before induction of anesthesia. prophylactic.edu/~rvp/old/RP_Anesthesia/Basics/Pacers. prophylactic.maintenance Atrium and/or Vent Arrest.