1. Pacemakers Presented by: Katie Cramer

2. Outline Electrical System of Heart Electrical System of Heart Indications for a Pacemaker Indications for a Pacemaker The Procedure The Procedure Post procedural Care and Follow-up Post procedural Care and Follow-up History of the pacemaker History of the pacemaker

3. Electrical System Sinoatrial node Sinoatrial node -heart’s natural pacemaker -located in the right atrium -stimulates right and left atria to contract & pump blood into ventricles

4. Electrical System Atrioventricular Node Atrioventricular Node -located between the atria and ventricles -transfers electrical signal from SA node to Bundle of His Bundle of His -located in the interventricular septum -splits into right and left branches -stimulates ventricles to contract

5. Electrical System Electrical impulses are documented and monitored on an electrocardiogram (EKG) Electrical impulses are documented and monitored on an electrocardiogram (EKG)

6. Indications for a Pacemaker Symptomatic Bradycardia Symptomatic Bradycardia Complete Heart Block Complete Heart Block

7. The Procedure

8. Patient Prep NPO at midnight before exam NPO at midnight before exam Arrive in Cath Lab Arrive in Cath Lab Vitals continuously monitored Vitals continuously monitored Skin scrubbed with betadine Skin scrubbed with betadine

9. Doctor’s Role Injects lidocaine Injects lidocaine Makes incision Makes incision -inferior to clavicle -through skin and subcutaneous layers Threads catheter through subclavian vein and into the heart Threads catheter through subclavian vein and into the heart The lead connects to the pacemaker and allows it to pace the heart’s electrical activity The lead connects to the pacemaker and allows it to pace the heart’s electrical activity

10. Technologist’s Role Assists Doctor Assists Doctor Washes out pocket with neomycin/polymicin Washes out pocket with neomycin/polymicin Sews incision back together after pacemaker insertion Sews incision back together after pacemaker insertion

11. Post-procedural care Chest x-ray -checks: -placement of leads -look for pneumothorax

12. Inpatient Care: 1-2 night stay in hospital Check site for bleeding and infection Patients treated with antibiotics Outpatient Care: Pacemaker checked every 2 weeks after 1 st month of insertion Assessed every other month Thorough testing every six months

13. History 1 st pacemakers date back to the early 1900s were external devices 1 st pacemakers date back to the early 1900s were external devices 1959 1 st implantable pacemaker 1959 1 st implantable pacemaker 1970s 1 st programmable pacemaker 1970s 1 st programmable pacemaker 1980s 1 st steroid-eluting lead used 1980s 1 st steroid-eluting lead used Pacemakers now more like a mini computer Pacemakers now more like a mini computer The sky is the limit! The sky is the limit!

14. Conclusion Pacemakers are useful tools that aide in treatment of heart arrhythmias Pacemakers are useful tools that aide in treatment of heart arrhythmias They can extend a patient’s quantity and quality of life They can extend a patient’s quantity and quality of life