Pacemakers & AICD

8/2/2019 Pacemakers & AICD

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Pacemaker & AICD

What Do You Need To Know?


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Pacemakers & AICDs

Why you need to know about them?

It is cardiologist problem!

Three million people worldwide have a pacemaker.

600,000 pacemakers are implanted each year.

It is not uncommon that Pts. Become obsessed afterimplantation.

Its complications might lead to mortality and morbidity


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Anatomy

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NBG-Code

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Pacemaker EKG

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Complications

1.Pocket complications.

2.Malfunction.

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Pacemaker Malfunction

I. Failure to pace (output)

II. Failure to capture

III.Problem with sensing: or

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Failure to Pace

If there is an absence of pacemakerspikes despite indication to pace.

BatteryLead

Over-sensing / Cross talk

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Failure to capture

Pacemaker spikes appears but no capture

Electrolytes

MI

Drugs

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Under-sensing

Pacemaker discharge despite intrinsiccardiac activity

Lead displacementFibrosis

MI

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Over-sensing

Inappropriate inhibition of pacing

Extra cardiac muscle activity

Device interference

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Case 1

68 yr. female with palpitation3 wks. Post Pacemaker insertion.

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Twiddlers Syndrome


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Case 2

49 yr. 3 days s/p pacemaker insertion

c/o SOB & palpitation with syncope

Cold on touch & diaphoretic

You obtained EKG which showed:

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Pulse 145

Bp. 90/47

What is wrong ?

Lead perforation & Tamponade


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Case 3

72 yr. male on pacerc/o chest pain & palpitation

EKG:

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Pacemaker Mediated Tachycardia

PMT


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Magnet effect on pacemaker

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Case 4

107 yr. male on pacerc/o dizziness SoB & palpitation

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Runaway Pacemaker


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Case 5

72 yr. malec/o dizziness

EKG

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What is your interpretation?


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Case 6

64 yr. lady on pacerc/o frequent syncopal attacks

EKG obtained

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Failure to sense and captureHyperkalemia


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Cardiac action potential

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Case 6

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Failure to sense and captureHyperkalemia


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Case 7

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Ventricular PseudofusionInferior STEMI

68 yr. lady on pacemakerc/o progressive SoB & fatigue

EKG:


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Your Spot Interpretation?

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A

B

C


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((AICDs))

Basic concepts:Success is probabilistic.

Pacing and Cardioversion most of the time.Your aim treating the rhythm according to

ACLS Protocols.

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(AICD) Nomenclature

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AICD Malfunction

I. Pocket. Pacemaker.

II. Device related.Inappropriate vs. Appropriate function

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Case 8

47 yr. male on AICD

c/o palpitation & SoB

HR 300 Bp 70/38 O2Sat 86 RR 34

pt. response to painful stimuli

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?Action


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Case 9

52 yr. lady on AICD

C/O palpitation followed by shock / 6hr.

On ED you attached her on monitor,which showed:

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Interpretation ?


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Case 10

64 yr. on AICDc/o syncope, his EKG

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Magnet on AICD

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Can You Tell Me What To Do?Cardiac Arrest

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AICD

Key points:Shock may lead to myocardial injury.

ECG usually normalize within 5 to 15 minutes.Biomarkers can be elevated post therapy.

Always remember, AICD = Cardiology involvement.

In emergencies, treat the rhythm not the device.

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Documents

Pacemakers & AICD