PERMANENT PACEMAKER

IYAN SOLIHIN
DI & INB PJN Harapan Kita
Jakarta
 Permanent Pacemaker (PPM)
Adalah alat bantu yang dapat
menghasilkan impulse listrik secara terus
menerus (kontinue) dan teratur (reguler)
terdiri dari generator (sumber listrik) dan
lead/elektrode (penghantar impulse ke
myocard) bersifat menetap (ditanam
/implanted) .
 The Implantable Pulse Generator (IPG) : metal can
.
(titanium) containing electronics/battery & an electrode
or lead connector header
Lead : Electrical connection between the pacemaker &
the heart
Single chamber

Triple chamber

Double chamber
Implantable Pacemaker Systems
Contain the Following Components:
Pulse generator: Lead

power source or
battery IPG

Leads or wires
Cathode (negative
electrode)
Anode
Anode (positive
electrode)
Body tissue
Cathode
 Lead Implantation
EPICARDIAL ENDOCARDIAL
Surgery Transvenous
Unipolar Uni-/Bipolar
Higher Threshold Lower Threshold
Polarity

_
+
 Leads
Aktive Passive
 Lead Fixation

Passive Fixation Passive Fixation Active

tines wings Fixation
screw-in
 Pacing Technology Secret

Pacemakers do only 2 things:

Pace

Sense
 NASPE/BPEG Pacemaker Code
st nd rd th
1 letter 2 letter 3 letter 4 letter
Chamber(s) Chamber(s) Response to Programmability &
Paced Sensed Sensing Rate modulation
O = None O = None O = None O = None
A = Atrium A = Atrium T = Triggered P = Simple programmability
V = Ventricle V = Ventricle I = Inhibited M = Multi programmability
D = Dual (A + V) D = Dual (A + V) D = Dual (T + I) C = Telemetry
R = Rate Modulation
 The NASPE/BPEG Generic (NBG)
Code
Position I II III

Category Chamber(s) Chamber(s) Response to

Paced Sensed Sensing
O = None O = None
None O
O == None
None
A == Atrium
Atrium A ==Atrium
A Atrium T = Triggered
V = Ventricle
Ventricle V
V == Ventricle
Ventricle III====Inhibited
Inhibited
Inhibited
Inhibited
D == Dual
D Dual(A+V)
(A+V) D == Dual
D Dual(A+V)
(A+V) D == Dual Dual(T+I)
(T+I)

Ventricle and Atrium:

AAI DualVentricle
1)Ventricle
Atrium ONLY:
ONLY:
Chamber and Atrium:
Pacing
+ VVI 2)1)Dual
Paced1)Chamber
Dual Chamber
Sensing Pacing
2) Dual
3)2)Response
Sensed NO SENSING
toChamber
Ventricular
sensing Sensing
Sensing
is ONLYAND
to inhibit
VVI
AAI
DDD
DOO
DVI
DDI 3) Response
3) trigger
ResponseNO RESPONSEto sensing
to sensing
a timing intervalisTOto SENSING
for is toother
the inhibit
inhibit
chamber
 Recommended Pacemaker
Modes
Diagnosis Optimal Alternative Innappropriate

SND AAIR AAI VVI , VDD

AVB DDD VDD AAI , DDI
SND & AVB DDDR , DDD , DDI AAI, VVI
DDIR
AF VVIR VVI AAI
Chronic
CSS DDI DDD AAI , VDD
Paced Rhythm Recognition
 pasca pemasangan

Monitor rate/ irama dengan Telemetri

monitor/ holter monitor
Pemeriksaan X-ray (cek paru,
generator dan leads)
Imobilisasi ektremitas yang
terpasang generator
Tehnik Septik/ aseptik pada lokasi
luka
Sebelum pulang cek pulse generator
(Program) di Klinik Pacemaker
Discharge Planning (rencana pulang)
1. Edukasi tentang perawatan luka jaga area
tetap bersih dan kering, hubungi dokter/ RS bila
ada tanda-tanda kemerahan, basah, berair,
demam atau menggigil.
2. Aktivitas (lengan yang terpasang generator)
Dilarang mengangkat beban lebih dari 4. 5 kg
Dilarang mengangkat tangan melebihi bahu
(minimal 6 minggu)
Hentikan aktivitas bila terlalu lelah.
Latih aktivitas minimal(jalan )
3. Edukasi tentang gangguan elektrical
/listrik
Selimut elektrik, microwave tidak
mengakibatkan inteferensi
Penggunaan telpon selular boleh pada posisi
yang berlawanan dg pulse generator
Hindari tegangan elektromagnetik yang tinggi
(pabrik dan sejenisnya)
Hindari pemeriksaan fisik mengandung
magnet (MRI)
Untuk ICD/ CRTD Konsultasi bila sering
menshock, mak 2-3 x / tahun ( dokter akan
kombinasi dengan obat)

4. Selalu membawa ID CARD

5. Follow Up
Follow up ( Clinic Pacemakers)
1st week; cek insision ,up hacting, patency laed,
evaluation symptom
2nd week: patency leads & Insision
4 7 week: patency lead & measure program
pacemaker ( not change), evaluation program
with symptom
3- 6 month: patency lead , evaluation symptom &
reprogram (Finall program)
0.5- 1 year : evaluation symptom measure
pacemaker
MAN OF THE YEAR