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Pacemaker

A pacemaker is an electronic device that provides electrical stimuli to the heart muscle to help regulate heartbeat. There are several types including permanent pacemakers which are implanted surgically and connected to leads threaded into the heart, and temporary pacemakers used until the patient's condition improves or a permanent pacemaker is implanted. Pacemakers are indicated for conditions like sinus node dysfunction and heart block. They are programmed to pace different chambers of the heart and can have single chamber, dual chamber, or multi-site capabilities. Nursing care involves monitoring pacemaker function and providing patient education about activity restrictions and signs of malfunction.

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57 views

Pacemaker

A pacemaker is an electronic device that provides electrical stimuli to the heart muscle to help regulate heartbeat. There are several types including permanent pacemakers which are implanted surgically and connected to leads threaded into the heart, and temporary pacemakers used until the patient's condition improves or a permanent pacemaker is implanted. Pacemakers are indicated for conditions like sinus node dysfunction and heart block. They are programmed to pace different chambers of the heart and can have single chamber, dual chamber, or multi-site capabilities. Nursing care involves monitoring pacemaker function and providing patient education about activity restrictions and signs of malfunction.

Uploaded by

LAWKUSH KUMAR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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PACEMAKER

PRINCY FRANCIS M
II Yr MSc (N)
JMCON
• 1932 - Albert Hyman coined term “Artificial
pacemaker”
• 1958 – first implantable pacemaker
designed by Rune Elmquist
Definition

A pacemaker is an electronic device that provides

electrical stimuli to the heart muscle.


INDICATION
- ACC, AHA and Heart Rhythm Society
 Class I (procedure to be performed)
• Sinus node dysfunction
• Acquired atrioventricular block
• Chronic bifascicular block
• After acute MI
INDICATION cont…
• Hypersensitive carotid sinus syndrome and
neurocardiogenic syncope
• After cardiac transplantation
• Pacing to prevent tachycardia
• Patients with congenital heart disease
 Class II procedures can be performed
but additional studies are needed
• Sustained VT
• Unexplained Syncope
• Nonischemic cardiomyopathy
• Permanent pacemaker that automatically detect and
pace to terminate tachycardia
• Cardiac sarcoidosis, Chagas disease
• Brugada syndrome

Class III procedures should not be performed


Permanent pacemakers
TYPES Temporary pacemakers
PERMANENT PACEMAKER

• The permanent pacemaker source is implanted subcutaneously

usually over the pectoral muscle on the patient’s nondominant side

• It is attached to pacing leads, which are threaded intravenously to

the right atrium and one or both ventricles.


TEMPORARY PACEMAKER
• Temporary pacemaker are used to support the patient
until patient condition improve or receive a permanent
pacemaker.
TYPES OF PACING

• Transvenous pacing –
internal jugular /
subclavian/ femoral
vein
• Epicardial pacing
• Transcutaneous pacing
TYPES BASED ON CHAMBER BEING PACED

• Single chamber pacing: one lead

• Dual chamber pacing : 2 lead

• Biventricular pacing / Cardiac resynchronization


therapy : 3 leads connecting to right atrium and both
ventricles
Components

 Electronic pulse generator – circuit and


battery
Rate (beats/mt)
Output (mA)
Sensitivity (mV)
 Pacemaker electrodes - leads
PACEMAKER CODE
• Universal code – NASPE and BPEG
First letter Second letter Third letter Fourth letter Fifth letter
Chamber Chamber sensed Response after Rate modulation Multisite pacing
paced Sensing
A – Atrium A – Atrium I - Inhibited O - No rate A – Atrium
responsiveness
V - Ventricle V - Ventricle T - Triggered R – Rate V - Ventricle
modulation
D - Dual D - Dual D - Dual D - Dual

O – None O - None O – None


Pacemaker spikes
MAGNET INHIBITION
Used to inhibit the device
Reprograms the pacer into an asynchronous pacing
mode; it does not turn the pacemaker off.
Determine the pacer’s battery to be replaced.
COMPLICATION
• Local infection at entry site
• Bleeding and hematoma
• Hemothorax
• Ventricular ectopy
• Dislocation of lead
• Phrenic nerve, diaphragmatic stimulation
• Cardiac tamponade
• Pacemaker syndrome
• Twiddler syndrome
PACEMAKER MALFUNCTION
• Loss of capture : complex doesnot follow pacing site
• Under sensing : pacing spike occurs at preset intervals despite of
patient’s rhythm.
• Oversensing : pacing doesn’t occur at preset interval
• Lack of pacing : total absence of pacing spikes
• Rhythmic diaphragmatic or chest wall twitching
NURSING MANAGEMENT

• Preoperative care
Assess knowledge and understanding level
Collect blood reports, Chest Xray, ECG, Echo,
Holter report
Get informed consent signed
Place ECG monitor electrodes away from
potential incision sites
Post operative care

• Provide postoperative monitoring, analgesia and care


• Obtain postop chest Xray to identify lead location and detect possible
complication
• Provide comfortable position. Restricting movement of extremities
• Assist with gentle ROM exercise atleast 3 times daily, beginning 24 hrs
after pacemaker implantation
• Monitor pacemaker function with cardiac monitoring and report
pacemaker problems to physician.
• Assess for dysrrhythmia and treat as indicated
• Provide pacemaker identification card.
Patient teaching
 Placement of the pacemaker generator and leads
 How the pacemaker works and rate at which it is set.
 Battery replacement
 How to take and record pulse rate.
 Incision care and signs of infection
 Signs of pacemaker malfunction to report including
dizziness, fainting, fatigue, weakness, chestpain or
palpitation.
 Activity restrictions. Limit to contact sports and avoid heavy
lifting for 2 months after surgery
 Avoid tight fitting clothings
 Notify all care providers of the pacemaker
 Carry pacemaker ID card
 Do not hold or use certain electrical devices over pacemaker
site including household appliances , antitheft devices.
 Maintain follow up care with physician
BIBLIOGRAPHY

• Woods LS, Froelicher SSE, Motzer US, Bridges EJ.


Cardiac Nursing. 6th edition. Baltimore: Wolters Kluwer
Publication; 2010
• Smeltzer S C, Bare B , Brunner &suddarth’s Medical
surgical nursing, edition 10th, ( 2000), Westline Industrial
drive, Missouri.
• Pacemaker - American Heart Association
www.heart.org/HEARTORG/Conditions/.../Pacemaker_U
CM_448480_Article.jsp

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