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Outline
1.Energy calculation 2.Pacemaker codes 3.Pacemaker configurations 4.Indications for pacemakers 5.Problems with pacemakers 6.Examples 7.Battery 8.Recent trends 9.Leads and electrode
Implantable pacemakers
Fixed Rate Demand R-Wave triggered Ventricular inhibited Atrial triggered Dual chamber
Pacemakers
Energy Calculation
Ep=(Vs2/RH) TD + VS IDT Ep - Energy delivered by the pacemaker to the heart during each pulse Vs Voltage RH Electrode heart resistance TD Pulse duration ID Drain current T- time period between successive pulse
Pacemaker Codes
Position Function 1 Chambers Paced 2 Chambers Sensed O 3 Response to Sensed Stimulus O 4 Rate Modulation? O (non-rate responsive)
R (rate responsive)
O (none)
A (atrium)
T (triggered)
V (ventricle)
I (inhibited)
Indications Temporary mode some-times used during surgery to prevent interference from electrocautery
Indications The combination of AV block and chronic atrial arrhythmias (particularly atrial fibrillation).
Indications Sick sinus syndrome in the absence of AV node disease or atrial fibrillation.
Indications AV block with intact sinus node function (particularly useful in congenital AV block).
Indications 1. The combination of AV block and SSS. 2. Patients with LV dysfunction and LV hypertrophy who need coordination of atrial and ventricular contractions to maintain adequate CO.
Causes:
Causes:
Causes:
Crosstalk
Causes:
Example 1
Example 2
Example 3
Example 4
Failure to Pace
Example 5
Failure to Sense
Pacemaker Battery
Mercury Batteries Biological power sources Nuclear batteries
o o
Lithium cells
Recent trends
Programmable Pacemakers Rate responsive