PACEMAKER

JACKIELYN N.CARGO, RN
OBJECTIVES

▪ to discuss pacemaker and its indications

▪ to identify the different types of pacemaker
▪ to determine possible complications of pacemaker
therapy
▪ to discuss basic ECG tracings of patients with pacemaker
▪ to provide health teachings
 ANATOMY OF THE
HEART
• The heart is a muscular organ that
contracts to pump blood to all parts of
the body

• Four chambers – atrium, ventricle

• A specialized conduction system
ensures the chambers contract in
correct order
• Sinoatrial Node (SA node) –pacemaker
of the heart
• Atrioventricular Node (AV node)

• Purkinje fiber – arising from AV

bundles, turn upward and spread
throughout the ventricular walls
WHAT IS A PACEMAKER?

▪ Pacemaker is an electronic device that provides electrical stimuli

to the heart
▪ it has two components:
▪ Pulse generator - contains the circuitry and battery that makes and
controls the timing of electrical impulses sent to the heart
▪ Pacemaker electrodes – convey the heart’s electrical activity through a
lead to the generator
▪ It can be permanent or temporary
INDICATIONS OF PACEMAKER THERAPY

TEMPORARY PACEMAKER
▪ Temporary maintenance of complete heart block before and during
permanent pacemaker insertion
▪ Complete heart block or advanced 2nd degree AV block with acute MI
▪ During surgical procedures or cardiac catheterization
▪ Overdrive of ventricular arrhythmias
INDICATIONS OF PACEMAKER THERAPY

PERMANENT PACEMAKER

▪ Complete heart block

▪ Sinus node dysfunction with symptomatic bradycardia
▪ Persistent complete heart block or advanced 2nd degree
AV block during MI and persists
TEMPORARY PACEMAKER
TEMPORARY PACEMAKER

▪ Transcutaneous pacemaker
▪ Epicardial pacemaker
▪ Transvenous pacemaker
TRANSCUTANEOUS PACEMAKER
TRANSCUTANEOUS PACEMAKER

▪ A temporary pacemaker therapy that uses adhesive

electrode pads applied directly to the chest in
anteroposterior or anteroapical configurations
▪ It is recommended for initial stabilization of
hemodynamically significant bradycardias of all types
▪ It may be act as a bridge until transvenous pacing or
other therapies can be applied
TRANSCUTANEOUS PACEMAKER
EPICARDIAL PACEMAKER
EPICARDIAL PACEMAKER

▪ A temporary pacemaker therapy

used during open heart surgery
should the surgical procedure
create AV block
▪ The pacemaker electrodes are
lightly sutured onto the
epicardium and brought through
the chest wall
▪ The pacing wire is connected to
an external pulse generator
EPICARDIAL PACEMAKER
TRANSVENOUS PACEMAKER
TRANSVENOUS PACEMAKER

▪ A temporary pacemaker therapy used as an alternative

to transcutaneous pacing
▪ The pacing wire is threaded through a major vein
(femoral, jugular or subclavian) under sterile conditions
and then passed to either the right atrium or right
ventricle guided by fluoroscopy
▪ The pacing wire is then connected to an external pulse
generator
TRANSVENOUS PACEMAKER
 ADVANTAGES AND DISADVANTAGES

ADVANTAGE DISADVANTAGE
TRANSCUTANEOUS -Readily available during emergency -Pads are disposable
-Non invasive -Patient discomfort

TRANSVENOUS -Bridge to permanent pacemaker -Site selection

placement -Limited mobility
-It can be used until there is no longer a -Thromboembolism
need for a pacemaker -Least stable wire position

EPICARDIAL -Backup emergency pacing for patients -Definitely temporary

during or after open heart surgery -Risk for infection
• Bradyarrhythmias -Risk for bleeding and cardiac tamponade
• Heart block after removal
• Supraventricular tachyarrhythmias
 REVIEW OF TERMINOLOGIES

▪ Asynchronous pacing (fixed) – delivery of electrical stimuli at a selected rate

regardless of the patient’s intrinsic cardiac activity
▪ Synchronous pacing (demand) – delivery of electrical stimulus only when needed
▪ Rate –the number of times the pulse generator will produce a pulse
▪ Capture – depolarization of the heart by an artificial stimulus; pacing spike followed
by a QRS
▪ Threshold – minimum amount of energy to initiate depolarization (capture);
measured in milliamps (mA)
▪ Output – is the current which produces a pulse ;
▪ Sensitivity – the ability of the pacemaker to detect intrinsic electrical activity;
measured in millivolts (mV)
PERMANENT PACEMAKER
PERMANENT PACEMAKER

▪ a pacemaker implanted surgically in either a transvenous of

epicardial approach
▪ the pacing lead is introduced into a vein then is threaded through
the chamber of the heart guided by fluoroscopy
▪ an incision is made in the chest to expose the heart and the pacing
lead is attached directly to the outer heart muscle
▪ the pacemaker is placed under the skin in either the upper chest
region or lower abdomen
 PACEMAKER MODES

North American Society of Pacing and Electrophysiology Group and the British Pacing and Electrophysiology
Group (NASPE-BPEG)
I II III IV V

CHAMBER (S) CHAMBER (S) MODE OF PROGRAMMABLE ANTITACHYCARDIA

PACED SENSED RESPONSE FUNCTIONS FUNCTIONS
V = ventricle V = ventricle T = triggered R = rate modulated O = none

A = atrium A = atrium I = inhibited C = communicating P = paced

D = dual D = dual D = dual M = multi S = shocks

programmable

O = none O = none 0 = none P = simple D = dual

programmable
O = none
VVI vs DDD

North American Society of Pacing and Electrophysiology Group and the British Pacing and
Electrophysiology Group (NASPE-BPEG)

I II III
CHAMBER (S) PACED CHAMBER (S) SENSED MODE OF RESPONSE

V = ventricle V = ventricle T = triggered

A = atrium A = atrium I = inhibited
D = dual D = dual D = dual
O = none O = none 0 = none
SINGLE CHAMBER PACEMAKER

▪ It uses one lead, placed either

in the right atrium or right
ventricle to sense or pace that
chamber
 DUAL CHAMBER PACEMAKER

▪ It requires two pacing leads, one

placed in the atrium, and the
other in the ventricle.
▪ It monitors both atrial and
ventricular activity to detect if
pacing is needed
▪ It mimics the heart’s normal
pumping mechanism
COMPLICATIONS OF PACEMAKER THERAPY

▪ Infection
▪ Bleeding or hematoma
▪ Lead perforation
▪ Lead dislodgement
▪ Arrhythmias
ECG
OVERSENSING
UNDERSENSING
NON CAPTURE / FAILURE TO CAPTURE
FAILURE TO PACE
HEALTH TEACHINGS

▪ Activities and exercise

▪ Electrical device and household appliances
▪ Airport screening and theft detectors
▪ Regular check up
Every act of kindness you sow on earth is a
fruitful harvest when you get to heaven.
Thank you!