Pacemaker complication - Revision history

Cmb23: /* Failure to Pace */

2023-10-29T19:58:45Z

Failure to Pace

← Revisión anterior		Revisión del 19:58 29 oct 2023
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	===Failure to Pace===		===Failure to Pace===
	*Failure to deliver a stimulus to the heart		*Failure to deliver a stimulus to the heart
	**Oversensing - most common cause: retrograde P’s, T’s, skeletal muscle myopotentials,		**Oversensing - most common cause: can present with symptomatic bradycardia, cause is retrograde P’s, T’s, skeletal muscle myopotentials, can be treated by placing a magnet over the pacemaker to switch to pacer mode
	**Crosstalk - type of oversensing where the ventricular lead senses atrial pacing stimulus, and ventilator output inhibited		**Crosstalk - type of oversensing where the ventricular lead senses atrial pacing stimulus, and ventilator output inhibited

Rossdonaldson1 at 17:18, 11 March 2021

2021-03-11T17:18:08Z

← Revisión anterior		Revisión del 17:18 11 mar 2021
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	==Background==		==Background==
			*All [[ICD]]s are also pacemakers (i.e. have pacing functionality), but not all pacemakers are ICDs (i.e. do not have shocking functionality)

	===Nomenclature===		===Nomenclature===
	*All [[ICD]]s are also pacemakers (i.e. have pacing functionality) but pacemakers are not ICDs (i.e. do not have shocking functionality)
	[[File:paced.gif\|thumb\|Paced rhythm with characteristic wide LBBB and pacer spikes]]		[[File:paced.gif\|thumb\|Paced rhythm with characteristic wide LBBB and pacer spikes]]
	[[File:xray-pacemaker.jpg\|thumb\|PA Xray with pacemaker]]		[[File:xray-pacemaker.jpg\|thumb\|PA Xray with pacemaker]]

Bobbycarey: /* Disposition */

2021-03-10T01:37:25Z

Disposition

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	==Disposition==		==Disposition==
			*Resolved Pacemaker-mediated Tachycardia without recurrence - discharge
	*Infection - admission with [[MRSA]] coverage antibiotics, consult to cardiology, with likely replacement of pacemaker after 4-6 weeks of IV antibiotics		*Infection - admission with [[MRSA]] coverage antibiotics, consult to cardiology, with likely replacement of pacemaker after 4-6 weeks of IV antibiotics
			*Pacing/sensing/capture issue - likely admit

	==See Also==		==See Also==

Bobbycarey: /* Background */

2021-03-02T21:56:49Z

Background

← Revisión anterior		Revisión del 21:56 2 mar 2021
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	==Background==		==Background==
	===Nomenclature===		===Nomenclature===
			*All [[ICD]]s are also pacemakers (i.e. have pacing functionality) but pacemakers are not ICDs (i.e. do not have shocking functionality)
	[[File:paced.gif\|thumb\|Paced rhythm with characteristic wide LBBB and pacer spikes]]		[[File:paced.gif\|thumb\|Paced rhythm with characteristic wide LBBB and pacer spikes]]
	[[File:xray-pacemaker.jpg\|thumb\|PA Xray with pacemaker]]		[[File:xray-pacemaker.jpg\|thumb\|PA Xray with pacemaker]]
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	! I \|\| II \|\| III \|\| IV \|\| V		! I \|\| II \|\| III \|\| IV \|\| V
	\|-		\|-
	\|+Generic code for ~~antibradycardia~~ pacing<ref>Bernstein AD. et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol 2002 Feb; 25(2) 260-4. lmid:11916002</ref>		\|+Generic code for pacing modes<ref>Bernstein AD. et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol 2002 Feb; 25(2) 260-4. lmid:11916002</ref>
	\| Chamber(s) paced \|\| Chamber(s) sensed \|\| Response to sensing \|\| Rate modulation \|\| Multisite pacing		\| Chamber(s) paced \|\| Chamber(s) sensed \|\| Response to sensing \|\| Rate modulation \|\| Multisite pacing
	\|-		\|-
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	*Cardiac Resynchronization Therapy- Conduction delay (>150msec with mortality benefit) in chronic systolic heart failure further decreases EF, increases remodeling and increased MR.		*Cardiac Resynchronization Therapy- Conduction delay (>150msec with mortality benefit) in chronic systolic heart failure further decreases EF, increases remodeling and increased MR.
	*Neurocardiogenic Syncope and Carotid Sinus Syndrome		*Neurocardiogenic Syncope and Carotid Sinus Syndrome

			===Lead Location===
			*Atrial
			**Right Atrial Appendage
			**Lateral RA wall
			*Right Ventricle
			**Apex
			**Septum
			*Left Ventricle (most commonly placed for cardiomyopathy or CHF)
			**Coronary veins along external LV wall via coronary sinus
			**Rarely, externally placed electrode during open surgical procedure

	===Additional Pacemaker Functions===		===Additional Pacemaker Functions===

Bobbycarey: /* Expected ECG Patterns */

2021-03-02T21:40:43Z

Expected ECG Patterns

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	*Leads in RV apex produce LBBB pattern with appropriate discordance		*Leads in RV apex produce LBBB pattern with appropriate discordance
	*New RBBB pattern may indicate lead in LV		*New RBBB pattern may indicate lead in LV
	* Bi-ventricular devices can produce either narrow or wide bizarre ~~QRS complexes~~ depending on device programming		* Bi-ventricular devices can produce paced QRS complexes that are either narrow or wide and bizarre, depending on device programming
	*Simultaneous depolarization of ventricles produces dominant R wave in V1		*Simultaneous depolarization of ventricles produces dominant R wave in V1

Bobbycarey: /* Expected ECG Patterns */

2021-03-02T21:37:51Z

Expected ECG Patterns

← Revisión anterior		Revisión del 21:37 2 mar 2021
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	*Leads in RV apex produce LBBB pattern with appropriate discordance		*Leads in RV apex produce LBBB pattern with appropriate discordance
	*New RBBB pattern may indicate lead in LV		*New RBBB pattern may indicate lead in LV
	*Simultaneous ~~depol~~ of ventricles produces dominant R wave in V1		* Bi-ventricular devices can produce either narrow or wide bizarre QRS complexes depending on device programming
			*Simultaneous depolarization of ventricles produces dominant R wave in V1

	===Plain Film Findings===		===Plain Film Findings===

Bobbycarey: /* Failure to Capture */

2021-03-02T21:35:36Z

Failure to Capture

← Revisión anterior		Revisión del 21:35 2 mar 2021
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	**Medical - drugs, myocardial disease, electrolytes		**Medical - drugs, myocardial disease, electrolytes
	**Technical - insufficient device output, lead dislodgment, fracture, insulation defect, ventricular wall perforation		**Technical - insufficient device output, lead dislodgment, fracture, insulation defect, ventricular wall perforation
			*Battery of End of Life (EOL)

	===Failure to Pace===		===Failure to Pace===

Bobbycarey: /* Differential Diagnosis */

2021-03-02T21:34:06Z

Differential Diagnosis

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	*Infection can cause severe sepsis		*Infection can cause severe sepsis
	*Tricuspid regurgitation		*Tricuspid regurgitation
	*Coiling (ie: [[Twiddler's Syndrome]]) [[File:Twiddler Syndrome.png\|thumb\|Twiddler Syndrome after large pocket and ~~pacemaker~~ wires ~~spinning on themselves~~]]		*Coiling (ie: [[Twiddler's Syndrome]]) [[File:Twiddler Syndrome.png\|thumb\|Twiddler Syndrome after large pocket and defibrillator wires coiled around the generator]]

	===Failure to Capture===		===Failure to Capture===

Bobbycarey: /* Background */

2021-03-02T21:31:19Z

Background

← Revisión anterior		Revisión del 21:31 2 mar 2021
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	*Cardiac Resynchronization Therapy- Conduction delay (>150msec with mortality benefit) in chronic systolic heart failure further decreases EF, increases remodeling and increased MR.		*Cardiac Resynchronization Therapy- Conduction delay (>150msec with mortality benefit) in chronic systolic heart failure further decreases EF, increases remodeling and increased MR.
	*Neurocardiogenic Syncope and Carotid Sinus Syndrome		*Neurocardiogenic Syncope and Carotid Sinus Syndrome

			===Additional Pacemaker Functions===
			*Can record rhythm strips of AF, VT, and VF episodes for later review
			*Keeps track of % of paced vs intrinsic beats
			*Keeps a rate histogram, as well as % of time spent in AF

	===Methods to Identify Manufacturer===		===Methods to Identify Manufacturer===

Bobbycarey: /* See Also */

2021-03-02T21:25:56Z

← Revisión anterior		Revisión del 21:25 2 mar 2021
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	*[[Medical device complications]]		*[[Medical device complications]]
	*[[In-Training Exam Review]]		*[[In-Training Exam Review]]
			*[[Implantable Cardioverter-Defibrillator complication]]

	==References==		==References==