Cardiac Pacemaker

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Contents 1 More Specific Terms 2 Introduction 3 Indications 4 Complications 5 Notes 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• transvenous pacemaker

Introduction

• Pacemaker nomenclature. A series of 3-5 letters in the following order denotes pacemaker function.
• chamber paced
• chamber sensed
• mode of response
• programmable functions
• special anti- tachyarrhythmia functions The following letters are used in pacemaker nomenclature. (NBG code) V ventricle A atrium D double 0 none T triggered, if senses P wave, triggers ventricular activity I inhibited P programmable rate M multi-programmable C communication B bursts N normal rate competition S scanning E external A active anti- tachycardia fixation Unipolar pacemakers (older) produce larger pacing spikes than bipolar pacemakers. Programmable functions include increased heart rate during activity by using a feedback loop, based on sensors that measure body vibration or respiratory rate.

Indications

• symptomatic bradycardia, unrelated to:

• pharmaceutical agents that can safely be discontinued
• transient ischemia

• sick sinus syndrome is the most common indication
• asymptomatic patients with type 2 second degree AV block
• 3rd degree AV block
• hypertrophic obstructive cardiomyopathy
• congenital complete heart block

Complications

• infection

• originate in subcutaneous pocket created for generator box
• etiologic agents
• coagulase-negative Staphylococcus
• Staphylococcus aureus
• management:

• removal of the generator box
• systemic antibiotics for 2 weeks
• epicardial & transvenous wires

• should also be removed if possible
• if not, 6 weeks of antibiotics therapy

• upper extremity deep vein thrombosis (10%)

Notes

• DDD pacers

• upper & lower limits

• heart rate above upper limit results in 2:1 block by the pacemaker

• hand-held metal detectors used for security screening probably do not affect pacemaker or ICD function [3,4]

More General Terms

• cardiovascular implantable electronic device (CIED)

Additional Terms

• cardiac device infection
• cardiac resynchronization therapy (CRT)
• implantable cardioverter defibrillator (ICD)
• indications for permanent cardiac pacemaker
• pacemaker syndrome

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
2. Zaidan JR et al Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter-Defibrillators: A Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Rhythm Management Devices. Developed by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Rhythm Management Devices: Anesthesiology: Volume 103(1) July 2005 pp 186-198 NGC guideline withdrawn 12/2010 [1]
3. Kolb CK et al. Do airport metal detectors interfere with implantable pacemakers or cardioverter-defibrillators? J Am Coll Cardiol 2003 Jun 4; 41:2054-9. PMID: [2]
   - Jilek C et al Safety of Screening Procedures With Hand-Held Metal Detectors Among Patients With Implanted Cardiac Rhythm Devices A Cross-sectional Analysis Annals of Internal Medicine November 1, 2011. 155(9):587-592 [3]
4. Jilek C et al. Safety of screening procedures with hand-held metal detectors among patients with implanted cardiac rhythm devices: A cross-sectional analysis. Ann Intern Med 2011 Nov 1; 155:587. PMID: [4]
5. National Guideline Clearinghouse ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). ngc-guideline: [5]

cardiac pacemaker