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Basic Pacing Concepts Part I. zIdentify the components of pacing systems and their respective functions zDefine basic electrical terminology zDescribe.

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Presentation on theme: "Basic Pacing Concepts Part I. zIdentify the components of pacing systems and their respective functions zDefine basic electrical terminology zDescribe."— Presentation transcript:

1 Basic Pacing Concepts Part I

2 zIdentify the components of pacing systems and their respective functions zDefine basic electrical terminology zDescribe the relationship of amplitude and pulse width defined in the strength duration curve zExplain the importance of sensing zDiscuss sources of electromagnetic interference (EMI) and patient/clinician guidelines related to these sources zUnderstand the need for and types of sensors used in rate responsive pacing Objectives

3 Pacing Systems

4 zThe heart generates electrical impulses that travel along a specialized conduction pathway zThis conduction process makes it possible for the heart to pump blood efficiently The Heart Has an Intrinsic Pacemaker

5 Ventricles Sinoatrial (SA) Node Atrioventricular (AV) Node Atria During Conduction, an Impulse Begins in the Sinoatrial (SA) Node and Causes the Atria to Contract

6 Atria Ventricles Bundle branches AV node SA node Then, the Impulse Moves to the Atrioventricular (AV) Node and Down the Bundle Branches, Which Causes the Ventricles to Contract

7 SA node zPrevent impulse generation in the SA node zInhibit impulse conduction AV node Diseased Heart Tissue May:

8 Implantable pulse generator (IPG) Lead wire(s) Implantable Pacemaker Systems Contain the Following Components:

9 zPulse generator: power source or battery zLeads or wires zCathode (negative electrode) zAnode (positive electrode) zBody tissue IPG Lead Anode Cathode Pacemaker Components Combine with Body Tissue to Form a Complete Circuit

10 zContains a battery that provides the energy for sending electrical impulses to the heart zHouses the circuitry that controls pacemaker operations Circuitry Battery The Pulse Generator:

11 zDeliver electrical impulses from the pulse generator to the heart zSense cardiac depolarization Lead Leads Are Insulated Wires That:

12 zEndocardial or transvenous leads zMyocardial/Epicardial leads Types of Leads

13 Transvenous Leads Have Different “Fixation” Mechanisms zPassive fixation –The tines become lodged in the trabeculae (fibrous meshwork) of the heart

14 Transvenous Leads zActive Fixation –The helix (or screw) extends into the endocardial tissue –Allows for lead positioning anywhere in the heart’s chamber

15 Myocardial and Epicardial Leads zLeads applied directly to the heart –Fixation mechanisms include: yEpicardial stab-in yMyocardial screw-in ySuture-on

16 Cathode zAn electrode that is in contact with the heart tissue zNegatively charged when electrical current is flowing Cathode

17 Anode zAn electrode that receives the electrical impulse after depolarization of cardiac tissue zPositively charged when electrical current is flowing Anode

18 Conduction Pathways zBody tissues and fluids are part of the conduction pathway between the anode and cathode Tissue Cathode Anode

19 zBegins in the pulse generator zFlows through the lead and the cathode (–) zStimulates the heart zReturns to the anode (+) During Pacing, the Impulse: Impulse onset *

20 zFlows through the tip electrode (cathode) zStimulates the heart zReturns through body fluid and tissue to the IPG (anode) A Unipolar Pacing System Contains a Lead with Only One Electrode Within the Heart; In This System, the Impulse: Cathode Anode - +

21 zFlows through the tip electrode located at the end of the lead wire zStimulates the heart zReturns to the ring electrode above the lead tip A Bipolar Pacing System Contains a Lead with Two Electrodes Within the Heart. In This System, the Impulse: Cathode

22 Unipolar and Bipolar Leads

23 Unipolar leads zUnipolar leads may have a smaller diameter lead body than bipolar leads zUnipolar leads usually exhibit larger pacing artifacts on the surface ECG

24 Bipolar leads zBipolar leads are less susceptible to oversensing noncardiac signals (myopotentials and EMI) Coaxial Lead Design

25 Lead Insulation May Be Silicone or Polyurethane

26 Advantages of Silicone-Insulated Leads zInert zBiocompatible zBiostable zRepairable with medical adhesive zHistorically very reliable

27 Advantages of Polyurethane-Insulated Leads zBiocompatible zHigh tear strength zLow friction coefficient zSmaller lead diameter

28 A Brief History of Pacemakers

29 Single-Chamber and Dual-Chamber Pacing Systems

30 Single-Chamber System zThe pacing lead is implanted in the atrium or ventricle, depending on the chamber to be paced and sensed

31 Paced Rhythm Recognition AAI / 60

32 Paced Rhythm Recognition VVI / 60

33 DisadvantagesAdvantages Advantages and Disadvantages of Single-Chamber Pacing Systems zImplantation of a single lead zSingle ventricular lead does not provide AV synchrony zSingle atrial lead does not provide ventricular backup if A-to-V conduction is lost

34 zOne lead implanted in the atrium zOne lead implanted in the ventricle Dual-Chamber Systems Have Two Leads:

35 Paced Rhythm Recognition DDD / 60 / 120

36 Paced Rhythm Recognition DDD / 60 / 120

37 Paced Rhythm Recognition DDD / 60 / 120

38 Paced Rhythm Recognition DDD / 60 / 120

39 zStimulate cardiac depolarization zSense intrinsic cardiac function zRespond to increased metabolic demand by providing rate responsive pacing zProvide diagnostic information stored by the pacemaker Most Pacemakers Perform Four Functions:

40 General Medtronic Pacemaker Disclaimer INDICATIONS Medtronic pacemakers are indicated for rate adaptive pacing in patients who may benefit from increased pacing rates concurrent with increases in activity (Thera, Thera-i, Prodigy, Preva and Medtronic.Kappa 700 Series) or increases in activity and/or minute ventilation (Medtronic.Kappa 400 Series). Medtronic pacemakers are also indicated for dual chamber and atrial tracking modes in patients who may benefit from maintenance of AV synchrony. Dual chamber modes are specifically indicated for treatment of conduction disorders that require restoration of both rate and AV synchrony, which include various degrees of AV block to maintain the atrial contribution to cardiac output and VVI intolerance (e.g., pacemaker syndrome) in the presence of persistent sinus rhythm Programmer The Medtronic 9790 Programmers are portable, microprocessor based instruments used to program Medtronic implantable devices The Model 9462 Remote Assistant™ is intended for use in combination with a Medtronic implantable pacemaker with Remote Assistant diagnostic capabilities. CONTRAINDICATIONS Medtronic pacemakers are contraindicated for the following applications:  Dual chamber atrial pacing in patients with chronic refractory atrial tachyarrhythmias.  Asynchronous pacing in the presence (or likelihood) of competitive paced and intrinsic rhythms.  Unipolar pacing for patients with an implanted cardioverter-defibrillator because it may cause unwanted delivery or inhibition of ICD therapy.  Medtronic.Kappa 400 Series pacemakers are contraindicated for use with epicardial leads and with abdominal implantation. WARNINGS/PRECAUTIONS Pacemaker patients should avoid sources of magnetic resonance imaging, diathermy, high sources of radiation, electrosurgical cautery, external defibrillation, lithotripsy, and radiofrequency ablation to avoid electrical reset of the device, inappropriate sensing and/or therapy Operation of the Model 9462 Remote Assistant™ Cardiac Monitor near sources of electromagnetic interference, such as cellular phones, computer monitors, etc. may adversely affect the performance of this device. See the appropriate technical manual for detailed information regarding indications, contraindications, warnings, and precautions. Caution: Federal law (U.S.A.) restricts this device to sale by or on the order of a physician.

41 Medtronic Leads For Indications, Contraindications, Warnings, and Precautions for Medtronic Leads, please refer to the appropriate Leads Technical Manual or call your local Medtronic Representative. Caution: Federal law restricts this device to sale by or on the order of a Physician. Note: This presentation is provided for general educational purposes only and should not be considered the exclusive source for this type of information. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in a particular situation.

42 Continued in Basic Pacing Concepts Parts II and III


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