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Pacemaker 2

Pacemaker 2. NMT354. Outline:. Sensing Under Sensing Over Sensing Infections. Single chamber. Dual chamber. Sensing. ° Ability of device to detect intrinsic cardiac activity. ° Under sensing : failure to sense. ° Over sensing : too sensitive to activity.

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Pacemaker 2

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  1. Pacemaker 2 NMT354

  2. Outline: • Sensing • Under Sensing • Over Sensing • Infections

  3. Single chamber

  4. Dual chamber

  5. Sensing ° Ability of device to detect intrinsic cardiac activity. ° Under sensing: failure to sense. ° Over sensing: too sensitive to activity.

  6. Under sensing: Failure to sense ° Pacer fails to detect an intrinsic rhythm ° Paces unnecessarily ° Patient may feel “extra beats” If an unneeded pacer spike falls in the latter portion of T wave, dangerous tachyarrhythmias or V fib may occur (R on T) TX: Increase sensitivity of pacer

  7. Over sensing: too sensitive to activity ° Pacer interprets noncardiacelectrical signals as originating in the heart. ° Detects extraneous signals such as those produced by electrical equipment or the activity of skeletal muscles (tensing, flexing of chest muscles, SUX) ° Inhibits itself from pacing as it would a true heart beat

  8. Over sensing On ECG: pauses longer than the normal pacing interval are present. Often, electrical artifact is seen. Deprived of pacing, the patient suffers CO2, feels dizzy/light-headed. Most often due to sensitivity being programmed too high. TX: Reduce sensitivity

  9. Infections • Pacemaker insertion is a surgical procedure: • 1% risk for bacteremia • 2% risk for wound or pocket infection • Usually occur soon after pacer insertion. • Presence of a foreign body complicates management.

  10. Infection • Cellulitisor pocket infection: • Tenderness and redness over the pacemaker itself. • Avoid performing a needle aspiration – damage the pacer. • Bacteremia: Staphylococcus • Empiric antibiotics should include vancomycin pending culture.

  11. Infection • Consult the pacemaker physician. • Draw blood cultures. • Give appropriate antibiotics. • Frequently the pacer and lead system need to be removed.

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