For the craziest medical doctors on earth who love cardiology and electrophysiology , for nuts and dreamers who try to make this world a better place ... how to follow up a patient with a pacemaker ? themed "Her" movie

1. How to follow up a patient with a
pacemaker?
Yasmeen Kamal
Tanta Rhythm Group

2. 1- Remote monitoring
•Trans Telephonic
•Via Internet
2-PaceMaker Clinics

3. Remember You are checking on a patient
Not a software
Remember Samanatha?

4. Recommendations for Permanent
Pacemaker Services
According to Canadian
recommendations
2011

5. Resource Requirements for Pacemaker Clinics
Human Resources:
Medical Director or Most Responsible Physician (MRP)
Pacemaker Follow-up Physicians
Registered Nurses and Allied Health Professionals

6. Documentation and Database Requirements

7. Equipment Resources
EchoCardiography , Exercise ECG , Tilt table test , up to EP unit

8. Content of Follow-up
Four Categories of Pacemaker-Monitoring Goals
according to:
HRS/EHRA Expert Consensus on the Monitoring of
Cardiovascular Implantable Electronic Devices (CIEDs)
2008
1-Patient-related
2-PaceMaker related
3-Disease related
4-Communication related

9. History and physical examination

10. Don’t forget to check on Wound
Every Visit
Be aware of :
Late device infection !!!!

11. History of cerebro vascular insult .. AF??
Chest pain
HF symptoms
Dizziness or syncope
edema or pain on the pacemaker sided limb
Palpitation
others

12. 12 Lead ECG
The Pacemaker ECGs are illustrated in separate lecture
Note that : The ECG is Your best friend
You can know a lot about the pacemaker functions
only from the ECG

13. Cherchez Le “P”

14. Chest X-ray
•Lead position
•Lead Fracture
•Other associations

15. Apply a Magnet
•Asynchronous pacing on applying the magnet
at magnet rate ”VOO , DOO”
•The magnet rate usually differs from the ususal programmed rate
•According to the manufacturer
•Reflects the status of the battery
•Some devices allow the magnet response to be programmed on & off

16. USE The Programmer
Match the programmer head with the pacemaker
and wait for interrogation

17. Start interrogation

18. Place the programmer head over the device

19. Medtronic
Boston
Saint Jude
Bitotronik

23. 1-capture Threshold voltage measurement
“at certain pulse width”
Remember the strength duration curve
Make sure that the safety margin is adequate

25. DON’T RELY ON EGM

26. 2-Sensing threshold
Measure intrinsic P and R wave endocardial signals
Adjust sensitivity

27. 3-Lead impedance
Compare Results with previous data
Check programmed data “ output ,
sensitivity , hysteresis , base rate , UTR
, PVARP , AMS , autocapture”

28. That was the measured data
Take a look on the memorized data

31. Remote monitoring

33. Take Home messages
1. You are a cardiologist and you have patients at the follow-up clinic ,
not smart phones
1. Collect and compare data
2. The 12 Lead ECG remains your best friend
3. Don’t trust the EGM alone
4. Devices are smart but you are smarter

34. Lots of data you obtain about patients lives from their devices
Does it feel good to share
your life details with
somebody?

35. Thank you