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Pacemaker
Ms. Shany Thomas
Asst. Professor
GHPSCN
An electronic device used to pace the
heart when the normal conduction pathway is
damaged or diseased.
Component of pacing system:
• Pulse Generator
• Pacing Lead
• Healthy Myocardium
FUNCTION OF PACEMAKER
• Pacing function
• Sensing function
• Capture function
PACING FUNCTION:
It is the ability of the pacemaker
to stimulate either the atrium, Ventricle, or
both chambers in sequence and initiate
electrical Depolarization and cardiac
contraction.
• Atrial pacing
• Ventricular pacing
• Atrio-ventricular pacing.
SENSING FUNCTION:
Cardiac pacemaker have the ability to
see intrinsic cardiac Activity when it occurs.
CAPTURE FUNCTION:
The ability to generate a response
from the heart [contraction] after electrical
stimulation is referred as capture.
TYPES OF PACEMAKER
• Permanent pacemaker
• Temporary pacemaker
 Transvenous pacing
 Epicardial pacing
 Transcutaneous pacing
Permanent pacemaker
• It is implanted totally with in the body. The
power source is implanted subcutaneously
usually over the pectoral muscle on the
patients non dominant side. The pacing leads
are threaded transvenously to the chamber to
be paced.
Indications
• Acquired AV block
• Second and third degree block
• Cardiomyopathy
• BBB
• SA Node dysfunction
• Tachydysrhythmias
Pace maker modes
• Fixed rate: fire constantly at a preset rate
with out regard to the electrical activity
of the patient’s heart
• Demand: it detects the hearts electrical
activity. Fires only when the electrical
activity of heart drops below the pre set
rate.
Temporary pacemaker
It has the power source outside the body
Types:
Transvenous pacemaker
Leads are threaded transvenously to the chambers
and attached to the power source
Epicardial pacing
The pacing leads are attached to the epicardium
during heart surgery
Transcutaneous pacemaker
Noninvasive, power source is attached to large
electrodes placed over the anterior and posterior chest
Trans venous pacing Epicardial pacing
Transcutaneous pacing
Nursing care
• Continuous ECG monitoring of heart rate & Rhythm.
• Monitor vital signs for every 15 minutes.
• Monitor urine output.
• Observe for the presence of dysarrhythmia.
• Avoid injury .
• Post insertion chest x-ray.
• Monitor signs &symptoms of haemothorax &
pneumothorax.
• Evaluate continuously for evidence of bleeding.
• Monitor for evidence of lead migration.
• Auscultate for pericardial friction rub.
• Provide an electrically safe environment.
• Prevent infection.
• Relieve anxiety.
Patient education
• Check pulse daily.
• Avoid weight lifting.[>20 lb]
• Avoid shower.
• Avoid lifting hand over shoulder level.
• Wear loose-fitting clothing.
• Avoid trauma to the area.
• Come for regular check up.
• Avoid close exposure to magnetic force,
radiation, metal detector etc
• Carry all time pacemaker identity card
• All electronic equipments should be grounded
and repaired

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Pacemaker

  • 2. An electronic device used to pace the heart when the normal conduction pathway is damaged or diseased. Component of pacing system: • Pulse Generator • Pacing Lead • Healthy Myocardium
  • 3. FUNCTION OF PACEMAKER • Pacing function • Sensing function • Capture function
  • 4. PACING FUNCTION: It is the ability of the pacemaker to stimulate either the atrium, Ventricle, or both chambers in sequence and initiate electrical Depolarization and cardiac contraction. • Atrial pacing • Ventricular pacing • Atrio-ventricular pacing.
  • 5. SENSING FUNCTION: Cardiac pacemaker have the ability to see intrinsic cardiac Activity when it occurs. CAPTURE FUNCTION: The ability to generate a response from the heart [contraction] after electrical stimulation is referred as capture.
  • 6. TYPES OF PACEMAKER • Permanent pacemaker • Temporary pacemaker  Transvenous pacing  Epicardial pacing  Transcutaneous pacing
  • 7. Permanent pacemaker • It is implanted totally with in the body. The power source is implanted subcutaneously usually over the pectoral muscle on the patients non dominant side. The pacing leads are threaded transvenously to the chamber to be paced.
  • 8. Indications • Acquired AV block • Second and third degree block • Cardiomyopathy • BBB • SA Node dysfunction • Tachydysrhythmias
  • 9.
  • 10. Pace maker modes • Fixed rate: fire constantly at a preset rate with out regard to the electrical activity of the patient’s heart • Demand: it detects the hearts electrical activity. Fires only when the electrical activity of heart drops below the pre set rate.
  • 11. Temporary pacemaker It has the power source outside the body Types: Transvenous pacemaker Leads are threaded transvenously to the chambers and attached to the power source Epicardial pacing The pacing leads are attached to the epicardium during heart surgery Transcutaneous pacemaker Noninvasive, power source is attached to large electrodes placed over the anterior and posterior chest
  • 12.
  • 13. Trans venous pacing Epicardial pacing Transcutaneous pacing
  • 14. Nursing care • Continuous ECG monitoring of heart rate & Rhythm. • Monitor vital signs for every 15 minutes. • Monitor urine output. • Observe for the presence of dysarrhythmia. • Avoid injury . • Post insertion chest x-ray. • Monitor signs &symptoms of haemothorax & pneumothorax. • Evaluate continuously for evidence of bleeding.
  • 15. • Monitor for evidence of lead migration. • Auscultate for pericardial friction rub. • Provide an electrically safe environment. • Prevent infection. • Relieve anxiety.
  • 16. Patient education • Check pulse daily. • Avoid weight lifting.[>20 lb] • Avoid shower. • Avoid lifting hand over shoulder level. • Wear loose-fitting clothing. • Avoid trauma to the area. • Come for regular check up.
  • 17. • Avoid close exposure to magnetic force, radiation, metal detector etc • Carry all time pacemaker identity card • All electronic equipments should be grounded and repaired