3. A gentleman who had a pacemaker
implanted 3 years ago came to
your clinic to check on his device.
Unfortunately he forgot his card
So…. HOW will you deal with him ?
5. 1. Mode of Pacing
2. Rate
3. Capture function
4. Sensing function
5. What is the underlying rhythm?
6. What to do next?
6. No atrial spikes, each spike is followed by ventricular
activity so It is Ventricular pacing.
HR =80 bpm ,
no intrinsic ventricular beats , underlying rhythm is AF.
7. What to do next ?
1-sensing function should be assessed by using
the specific programmer
2-CHADsVaSc score is calculated to assess
the need of OAC
8. North American Society of Pacing and Electrophysiology/British Pacing and
Electrophysiology Group
Modes of pacing
10. Mode :
Here , We can see 2 spikes.
One preceding the p wave and the other is preceding the
R wave and pacing is sequential
So it is a Dual Chamber Pacemaker.
Rate:
By Using Calibers from one atrial spike to the next one.
Capture:
Each atrial spike is followed by atrial depolarization
and each ventricular spike is followed by Vent. dep.
Sensing Function :
Couldn’t be assessed .. 100 % pacing
11. The underlying Rhythm :
It is probably Bi-nodal disease
What to do next?
Check the sensing function using the
programmer
By lowering both atrial and ventricular rates
14. There are pacemaker spikes followed by atrial activity .
There is association between each paced atrial activity and
Intrinsic ventricular activity
Mode is : AAI / DDD
Rate : AP-AP
Capture function of the atrium is appropriate
Sensing function : Atrial sensing couldn’t be assessed
Underlying Rhythm : SA nodal disease
What to do next?
Check the mode of pacing
If DDD you should test ventricular capture
And atrial sensing should be assessed in either modes
15. DDD
AS – VP
Capture : ventricular capture is appropriate
sensing : Atrial sensing function is appropriate
Underlying rhythm : AV nodal disease
What to do next? Check ventricular sensing by prolonging AV dela
18. Capture beat: an intrinsic beat that captures
the ventricle
Fusion: a combination between intrinsic and
paced events
Pseudofusion: occurs when a spike falls on
an intrinsic beat
26. This strip was seen in a Holter Monitoring of
a patient who had a VVIR pacemaker and was
recently Complaining of dizziness while
playing Basket ball ?
Oversensing of myopotentials of pectoralis major muscle
Oversensing Leads to Underpacing
27. The pacemaker fails to generate an impulse
What is called “Failure of output”
Ventricular Oversensing