5. INDICATION
- ACC, AHA and Heart Rhythm Society
Class I (procedure to be performed)
• Sinus node dysfunction
• Acquired atrioventricular block
• Chronic bifascicular block
• After acute MI
6. INDICATION cont…
•Hypersensitive carotid sinus syndrome and
neurocardiogenic syncope
•After cardiac transplantation
•Pacing to prevent tachycardia
•Patients with congenital heart disease
7. Class II procedures can be performed
but additional studies are needed
• Sustained VT
• Unexplained Syncope
• Nonischemic cardiomyopathy
• Permanent pacemaker that automatically detect and
pace to terminate tachycardia
• Cardiac sarcoidosis, Chagas disease
• Brugada syndrome
Class III procedures should not be performed
9. PERMANENT PACEMAKER
• The permanent pacemaker source is implanted subcutaneously
usually over the pectoral muscle on the patient’s nondominant side
• It is attached to pacing leads, which are threaded intravenously to
the right atrium and one or both ventricles.
10. TEMPORARY PACEMAKER
• Temporary pacemaker are used to support the patient
until patient condition improve or receive a permanent
pacemaker.
12. TYPES BASED ON CHAMBER BEING PACED
• Single chamber pacing: one lead
• Dual chamber pacing : 2 lead
• Biventricular pacing / Cardiac resynchronization
therapy : 3 leads connecting to right atrium and both
ventricles
14. PACEMAKER CODE
• Universal code – NASPE and BPEG
First letter
Chamber
paced
Second letter
Chamber sensed
Third letter
Response after
Sensing
Fourth letter
Rate modulation
Fifth letter
Multisite pacing
A – Atrium A – Atrium I - Inhibited O - No rate
responsiveness
A – Atrium
V - Ventricle V - Ventricle T - Triggered R – Rate
modulation
V - Ventricle
D - Dual D - Dual D - Dual D - Dual
O – None O - None O – None
16. MAGNET INHIBITION
Used to inhibit the device
Reprograms the pacer into an asynchronous pacing
mode; it does not turn the pacemaker off.
Determine the pacer’s battery to be replaced.
17. COMPLICATION
• Local infection at entry site
• Bleeding and hematoma
• Hemothorax
• Ventricular ectopy
• Dislocation of lead
• Phrenic nerve, diaphragmatic stimulation
• Cardiac tamponade
• Pacemaker syndrome
• Twiddler syndrome
18. PACEMAKER MALFUNCTION
• Loss of capture : complex doesnot follow pacing site
• Under sensing : pacing spike occurs at preset intervals despite of
patient’s rhythm.
• Oversensing : pacing doesn’t occur at preset interval
• Lack of pacing : total absence of pacing spikes
• Rhythmic diaphragmatic or chest wall twitching
19. NURSING MANAGEMENT
• Preoperative care
Assess knowledge and understanding level
Collect blood reports, Chest Xray, ECG, Echo,
Holter report
Get informed consent signed
Place ECG monitor electrodes away from
potential incision sites
20. Post operative care
• Provide postoperative monitoring, analgesia and care
• Obtain postop chest Xray to identify lead location and detect possible
complication
• Provide comfortable position. Restricting movement of extremities
• Assist with gentle ROM exercise atleast 3 times daily, beginning 24 hrs
after pacemaker implantation
• Monitor pacemaker function with cardiac monitoring and report
pacemaker problems to physician.
• Assess for dysrrhythmia and treat as indicated
• Provide pacemaker identification card.
21. Patient teaching
Placement of the pacemaker generator and leads
How the pacemaker works and rate at which it is set.
Battery replacement
How to take and record pulse rate.
Incision care and signs of infection
Signs of pacemaker malfunction to report including
dizziness, fainting, fatigue, weakness, chestpain or
palpitation.
22. Activity restrictions. Limit to contact sports and avoid heavy
lifting for 2 months after surgery
Avoid tight fitting clothings
Notify all care providers of the pacemaker
Carry pacemaker ID card
Do not hold or use certain electrical devices over pacemaker
site including household appliances , antitheft devices.
Maintain follow up care with physician
23. BIBLIOGRAPHY
• Woods LS, Froelicher SSE, Motzer US, Bridges EJ.
Cardiac Nursing. 6th edition. Baltimore: Wolters Kluwer
Publication; 2010
• Smeltzer S C, Bare B , Brunner &suddarth’s Medical
surgical nursing, edition 10th, ( 2000), Westline Industrial
drive, Missouri.
• Pacemaker - American Heart Association
www.heart.org/HEARTORG/Conditions/.../Pacemaker_U
CM_448480_Article.jsp