- Pacemakers
Link:frcamindmaps.org/patientconditions2/icd/icd.html
- Early PPM were unipolar (newer ones are bipolar) and were more prone to electrical interference
- Classification
- Letters 1-3 are the basic anti-bradycardia functions
- I - Paced
- O = none
- A = atria
- V = ventricle
- D = dual
- II - Sensed
- III - Response
- D = dual (T&I)
- O = none
- I = inhibited
- T = triggered
- IV
- Programmability (pre-2002)
- O = none
- M = multi-programmability
- R = rate modulation
- C = communicating
- P = simple programmable
- Rate modulation (revised post-2002)
- O = none
- R = rate modulation
- V
- Anti-tachycardia function (pre-2002)
- S = shock
- P = paced
- O = none
- D = dual
- Multisite pacing (revised post 2002)
- O = none
- A = atria
- V = ventricle
- D = dual (A&V)
- Class 1 indications
- 3rd degree AV block
- Symptommatic 2nd degree block
- Chronic bi/tri fascicular block (if symptomatic 2nd/3rd degree block occurs intermittently)
- Post MI persistent AV block
- Sick Sinus Syndrome
- Hypersensitive carotid sinus syndrome
- Symptommatic bradyarrhthmias post-transplant
- Management of PPM
- Check notes for indication, date of insertion and recent checks
- Note the mode of action of the PPM
- If rate modulator function, this should be de-activated prior to anaesthesia
- Switched to bipolar mode (less prone to interference)
- Routine Ix
- ECG
- Signs of capture
- Underlying rhythms
- CXR
- Assess for lead fracture
- Position of pacing box
- Evidence of CCF
- Not always routinely required
- Electrolytes
- Abnormalities can cause loss of capture
- Avoid sux if possible due to fasciculations
- Ensure U&Es normal
- Limit monopolar use
- Plate distant if used at all
- Have a contingency plan
- Percussive pacing
- Isoprenaline
- External pacing (80mA)
- Transvenous and transoesophageal pacing can be done but longer to set up
- Magnets
- Should not be used during surgery
- Post op
- Ensure PPM checked post-op
- Problems in hospital
- MRI (contraindicated)
- Monopolar diathermy
- Causes inhibition or revert to fixed rate mode
- Lithotripsy
- Ok to use if > 6 inches from PPM
- Rate modulation should be deactivated
- Shivering
- Can confuse rate modulators
- PNS & TENS
- Generally safe assuming not in close proximity
- Defibrillation
- Risks of malfunction is slight assuming pads are away from box
- CEACCP
Link:ceaccp.oxfordjournals.org/content/1/6/166.full.pdf
- Anaesthesia
Link:onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2006.04722.x/epdf
- Anaesthesia
Link:onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2007.04950.x/epdf
- PACEMAKERS EXPLAINED
Link:www.cardiacengineering.com/pacemakers-wallace.pdf