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Pacemaker Implantation

Pacemaker Implantation. Pacemaker Implantation. Pre-implantation Clinical assessment of patient Age Symptons Underlying cardiac rhythm Underlying medical state Size Evaluation of daily living activities Future needs. Pacemaker Implantation. Temporary pacing Access - Subclavian

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Pacemaker Implantation

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  1. Pacemaker Implantation

  2. Pacemaker Implantation • Pre-implantation • Clinical assessment of patient • Age • Symptons • Underlying cardiac rhythm • Underlying medical state • Size • Evaluation of daily living activities • Future needs

  3. Pacemaker Implantation • Temporary pacing • Access - Subclavian - External / Internal jugulars - Femoral - Brachial - Surgical (epicardial) • Emergency Pacing - Oesophageal - Transthoracic - Transcutaneous

  4. Pacemaker Implantation • Permanent pacing • Access - Subclavian - Cephalic • Lead / Implantable Pulse Generator (IPG) placement site • Dominant side / patient activities • Anatomy / venous access • ? Previous intervention / infection • Concommitent therapy ... surgery / ICD • Experience of operator

  5. SubclavianArtery External Jugular SubclavianVein Internal Jugular CephalicVein Aorta SuperiorVena Cava PulmonaryArtery InferiorVena Cava Diaphragm Lung Access - Blood Vessels 1 - Anatomy 5

  6. Left Atrium Pulmonary Valve Mitral Valve Aortic Valve Right Atrium Tricuspid Valve Left Ventricle Right Ventricle Access - Cardiac Chambers 1 - Anatomy 6

  7. Pacemaker Implantation • Implantation analysis • 3 lead ECG monitor / recorder • chest lead - unipolar Electrogram (EGM) • Electrophysiology amp - bipolar EGM • Pacing system analyzer (PSA) • Documentation • patient demographics • medical history • IPG data • other implant data Cont/.....

  8. Pacemaker Implantation • Implantation analysis cont/..... • Sterile connector cables • IPG programmer + software • Magnet • Sterile accessories • Spare batteries, connectors etc.

  9. Signal Pacemaker Implantation Signal Amplitude / Slew Rate

  10. Pacemaker Implantation Signal Frequency

  11. Pacemaker Implantation • Measurements • 1.Sensing threshold • Amplitude (Minimum : “P” - 2mV , “R” - 5mV) • Slew rate • Frequency content • Duration Cont/.....

  12. Pacemaker Implantation • Measurements • 2.Pacing threshold • (Measured amplitude at various pulse widths) • Paced rate > = 20 ppm above spontaneous rate • Decrement variable output : Threshold < 1V @ 0.5ms • Impedance measurement : 300 - 1000 ohms .... calculated / displayed • Intracardiac electrogram .... PSA .... ECG machine .... Monitoring system Cont/.....

  13. Pacemaker Implantation • Measurements • 3.Lead stability • 1V output, or 2X diastolic threshold (min. 1V) • 10V output for diaphragm stimulation test • Lead sutured in position • Re-measure sensing / pacing characteristics • Dual-chamber system - Measure Retrograde Conduction Time - Adjust PSA mode • Interrogate / Optimise IPG • Confirm labelling information Cont/.....

  14. Pacemaker Implantation • Measurements • 4.Lead Connection • Lead attached to IPG, setscrew tightened and sealed with cap • IPG inserted • Ascertain correct sensing / pacing function of system. Apply magnet if required. • Complete all documentation - pacemaker clinic / hospital records - manufacturer’s file / central database

  15. Implant Workshop

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