Physiologic electrical activity (T waves, muscle potentials).New intrinsic arrhythmia (AF has a smaller depolarization than sinus beat), AMI, electrolyte abnormalities, lead separation, battery depletion.Voltages of patient's intrinsic QRS complex is too low to be detected.Failure to sense results in a paced beat on top of an intrinsic beat (as the device is "unaware" of the intrinsic beat").Normal function: a sensed myocardial depolarization greater than the programmed threshold causes inhibition of pacing.Crosstalk - type of oversensing where the ventricular lead senses atrial pacing stimulus, and ventilator output inhibited.Oversensing - most common cause: retrograde P’s, T’s, skeletal muscle myopotentials,.Failure to deliver a stimulus to the heart.Technical - insufficient device output, lead dislodgment, fracture, insulation defect, ventricular wall perforation.Medical - drugs, myocardial disease, electrolytes.Functional - refractory myocardium, desensitized local tissue around the lead.Delivery of pacing stimulus without depolarization.Twiddler Syndrome after large pocket and defibrillator wires coiled around the generator Typically occurs shortly after placement.2% local wound infection 1% sepsis/bacteremia.Unipolar Cautery - can cause sensing and pacing malfunction as well as reprogrammingĭifferential Diagnosis Pacemaker Malfunction Problems with pocket.Cardioversion: Use AP pads >8cm from device to minimize adverse effects.MRI: mostly safe, consult cards on device specific recs.Airport security: may trigger alarm, no alteration of activity.Cell phones: do not interact with device.Manufacturer code on pulse generator is visible on Chest Xray.Boston Scientific Inc.: 100 bpm 85 bpm when battery is ready for replacement.Jude Medical Inc.: 98.6 bpm 86.3 bpm when battery is ready for replacement Medtronic Inc.: 85 bpm 65 bpm when battery is ready for replacement.Magnet mode - with placement of a magnet over the device, the mode changes to asynchronous (i.e.(recently acquired by Abbott, Inc.) (1-80) Manufacturer Hotline has patient database.Patient most often has a pocket card indicating manufacturer.Keeps a rate histogram, as well as % of time spent in AF.Keeps track of % of paced vs intrinsic beats.Can record rhythm strips of AF, VT, and VF episodes for later review.Rarely, externally placed electrode during open surgical procedure.Coronary veins along external LV wall via coronary sinus.Left Ventricle (most commonly placed for cardiomyopathy or CHF).Neurocardiogenic Syncope and Carotid Sinus Syndrome.Cardiac Resynchronization Therapy- Conduction delay (>150msec with mortality benefit) in chronic systolic heart failure further decreases EF, increases remodeling and increased MR.After Acute MI-high mortality with persistent AV block post MI.Chronic Bifascicular or Trifascicular block.Acquired AV block- 3rd degree block and 2nd degree type II.Sinus Node Dysfunction-sinus bradycardia/arrest, sinoatrial block, chronotropic incompetence, a-fib.His one great achievement is being the father of three amazing children.Generic code for pacing modes Chamber(s) paced He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of , the RAGE podcast, the Resuscitology course, and the SMACC conference. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.Īfter finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne.
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