This document discusses perioperative management of patients with cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators. It covers preoperative evaluation and preparation including device interrogation, reprogramming if needed to asynchronous mode or suspension of anti-tachycardia functions. Intraoperative monitoring focuses on ECG to evaluate pacing and detect interference. Risks of electromagnetic and mechanical interference are discussed along with strategies to minimize risks like external pacing/defibrillation pads if suspending device functions. Care is needed during procedures like central line placement to avoid device inhibition or inappropriate shocks.
Emergency Department ICD and pacemaker issuesSCGH ED CME
This document summarizes a talk given on device checks and outcomes, device interrogation, magnet operation for ICDs and pacemakers, and CareLink Express status in Western Australia. Some key points:
- Common reasons for device checks in the ED include syncope, palpitations, device beeping, shocks, and patient feeling unwell. Device interrogation and magnet operation were demonstrated.
- Pseudomalfunctions are ECG findings that appear abnormal but represent normal device function, like rate changes from magnet use or device algorithms.
- Magnet application sets pacemakers to asynchronous mode and inhibits ICD therapy temporarily.
- CareLink Express allows remote device interrogation and is available at various hospitals and clinics in
A patient with pacemaker presents a complex challenge to the attending anaesthesiologist. The mode of management will be according to the type of pacemaker implanted. This presentation discusses in brief the peri-operative consideration in a patient with pacemaker.
The document discusses pacemakers and internal cardiac defibrillators, including their history, indications for use, effects of anesthesia, preoperative evaluation, intraoperative management, factors affecting function, and postoperative care. It covers topics like choosing the appropriate anesthesia technique to avoid interfering with the devices, monitoring patients intraoperatively, and what to do in case of pacemaker failure like temporary pacing or CPR.
A pacemaker is an electronic device that provides electrical stimulation to the heart muscle. Pacemakers were first developed in the 1950s and have since become implantable devices used to treat conditions like sinus node dysfunction and heart block. There are permanent and temporary pacemakers that can be single chamber, dual chamber, or multisite devices. Pacemakers are implanted surgically and connected to the heart with leads to provide pacing in the appropriate chambers. Nursing care involves preoperative teaching, postoperative monitoring for complications, assessing pacemaker function, and educating patients.
A pacemaker is an electronic device that provides electrical stimulation to the heart muscle. Pacemakers were first developed in the 1950s and have since become implantable devices used to treat conditions like sinus node dysfunction and heart block. There are permanent and temporary pacemakers that can be single chamber, dual chamber, or multisite devices. Pacemakers are implanted surgically and connected to the heart with leads to provide pacing in the appropriate chambers. Nursing care involves preoperative teaching, postoperative monitoring for complications, assessing pacemaker function, and educating patients.
This document discusses various implantable cardiac devices including pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and cardiac assist devices. It describes the components, indications, and complications of pacemakers and ICDs. It also covers topics such as pacemaker/ICD terminology, programming, interactions with defibrillation, and transcutaneous pacing. Cardiac assist devices are briefly discussed, noting examples like LVADs, BiVADs, and total artificial hearts.
The document discusses subcutaneous implantable cardioverter defibrillators (S-ICDs) and leadless pacemakers as alternatives to transvenous ICD systems. S-ICDs avoid the risks of transvenous leads but do not provide antitachycardia pacing or bradycardia support. Studies show S-ICDs effectively detect and treat ventricular arrhythmias similar to transvenous ICDs. However, S-ICDs have a higher risk of inappropriate shocks and pocket infections compared to transvenous ICDs. Leadless pacemakers eliminate transvenous leads but have not yet demonstrated long-term reliability.
Patients with pacemaker anaesthetic implicationsGowri Shankar
This document provides information on cardiac implanted electronic devices (CIEDs) such as pacemakers and implantable cardioverter defibrillators (ICDs). It discusses the basics of CIED functions, indications for use, and anesthetic management in the preoperative, intraoperative and postoperative periods. Special considerations for CIED patients include monitoring, preventing device malfunction from electrosurgery or other sources, and having temporary pacing equipment available.
Emergency Department ICD and pacemaker issuesSCGH ED CME
This document summarizes a talk given on device checks and outcomes, device interrogation, magnet operation for ICDs and pacemakers, and CareLink Express status in Western Australia. Some key points:
- Common reasons for device checks in the ED include syncope, palpitations, device beeping, shocks, and patient feeling unwell. Device interrogation and magnet operation were demonstrated.
- Pseudomalfunctions are ECG findings that appear abnormal but represent normal device function, like rate changes from magnet use or device algorithms.
- Magnet application sets pacemakers to asynchronous mode and inhibits ICD therapy temporarily.
- CareLink Express allows remote device interrogation and is available at various hospitals and clinics in
A patient with pacemaker presents a complex challenge to the attending anaesthesiologist. The mode of management will be according to the type of pacemaker implanted. This presentation discusses in brief the peri-operative consideration in a patient with pacemaker.
The document discusses pacemakers and internal cardiac defibrillators, including their history, indications for use, effects of anesthesia, preoperative evaluation, intraoperative management, factors affecting function, and postoperative care. It covers topics like choosing the appropriate anesthesia technique to avoid interfering with the devices, monitoring patients intraoperatively, and what to do in case of pacemaker failure like temporary pacing or CPR.
A pacemaker is an electronic device that provides electrical stimulation to the heart muscle. Pacemakers were first developed in the 1950s and have since become implantable devices used to treat conditions like sinus node dysfunction and heart block. There are permanent and temporary pacemakers that can be single chamber, dual chamber, or multisite devices. Pacemakers are implanted surgically and connected to the heart with leads to provide pacing in the appropriate chambers. Nursing care involves preoperative teaching, postoperative monitoring for complications, assessing pacemaker function, and educating patients.
A pacemaker is an electronic device that provides electrical stimulation to the heart muscle. Pacemakers were first developed in the 1950s and have since become implantable devices used to treat conditions like sinus node dysfunction and heart block. There are permanent and temporary pacemakers that can be single chamber, dual chamber, or multisite devices. Pacemakers are implanted surgically and connected to the heart with leads to provide pacing in the appropriate chambers. Nursing care involves preoperative teaching, postoperative monitoring for complications, assessing pacemaker function, and educating patients.
This document discusses various implantable cardiac devices including pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and cardiac assist devices. It describes the components, indications, and complications of pacemakers and ICDs. It also covers topics such as pacemaker/ICD terminology, programming, interactions with defibrillation, and transcutaneous pacing. Cardiac assist devices are briefly discussed, noting examples like LVADs, BiVADs, and total artificial hearts.
The document discusses subcutaneous implantable cardioverter defibrillators (S-ICDs) and leadless pacemakers as alternatives to transvenous ICD systems. S-ICDs avoid the risks of transvenous leads but do not provide antitachycardia pacing or bradycardia support. Studies show S-ICDs effectively detect and treat ventricular arrhythmias similar to transvenous ICDs. However, S-ICDs have a higher risk of inappropriate shocks and pocket infections compared to transvenous ICDs. Leadless pacemakers eliminate transvenous leads but have not yet demonstrated long-term reliability.
Patients with pacemaker anaesthetic implicationsGowri Shankar
This document provides information on cardiac implanted electronic devices (CIEDs) such as pacemakers and implantable cardioverter defibrillators (ICDs). It discusses the basics of CIED functions, indications for use, and anesthetic management in the preoperative, intraoperative and postoperative periods. Special considerations for CIED patients include monitoring, preventing device malfunction from electrosurgery or other sources, and having temporary pacing equipment available.
- The document discusses the history and evolution of implantable cardioverter defibrillators (ICDs). Key points include:
- ICDs were first conceived in 1966 and the first human implant was in 1980.
- ICDs function by sensing cardiac rhythms, detecting arrhythmias like ventricular tachycardia or fibrillation, and delivering electrical therapies like anti-tachycardia pacing or shocks to treat them.
- Important aspects of ICD function include sensing, detection algorithms, therapy delivery, and troubleshooting problems. Studies show programming ICDs more conservatively with longer detection intervals and fewer unnecessary therapies can reduce inappropriate shocks and mortality.
This document discusses pacemakers, including their history, components, types, functions, programming, complications, and clinical management. It provides details on pacemaker technology, how they treat arrhythmias, and considerations for patients with pacemakers during medical procedures or surgery.
The document discusses cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. It covers how each device functions, their indications for use, and programming options. When providing anesthesia for patients with CIEDs, special precautions must be taken to avoid electromagnetic interference that could disrupt device function or sensing. This includes reprogramming devices if needed and monitoring patients closely during and after procedures.
This document discusses considerations for surgery in patients with implantable cardioverter-defibrillators (ICDs) or pacemakers. Electrocautery can cause electromagnetic interference that temporarily or permanently affects the device's functioning by resetting modes, inhibiting pacing, or triggering ICD shocks. The impact depends on factors like device type, lead placement, and whether the patient relies on pacing. Evaluation involves assessing the device and settings. Measures like using bipolar cautery, maximizing distance between devices and cautery, and magnet placement can reduce risks. After surgery, devices may need reprogramming and checking.
In this system Atmega controller is used to scan ECG signal and search for pattern in common range, if the pattern will be in normal range then it gives the report of being normal if it is found that it is not in normal range then the person is suffering from some kind of heart disease.
- Implantable cardioverter defibrillators (ICDs) are implanted inside the body to detect abnormal heart rhythms and deliver electrical shocks or pacing to correct life-threatening arrhythmias and reduce the risk of sudden cardiac death. ICDs continuously monitor heart rate and rhythm and can deliver low- or high-energy shocks when ventricular fibrillation or ventricular tachycardia is detected.
- ICD implantation involves placing the generator under the skin in the chest and threading leads through veins to the heart to detect rhythms. Newer dual-chamber or biventricular ICDs have additional leads. ICDs must be replaced every 5-10 years when batteries deplete,
Telemedicine System For Cardiac PatientsSharad Karwa
The aim of this project is to create a personalized heart monitoring system using smart phones and electrodes and mobile application which is capable of monitoring the health of high risk cardiac patients. The smart phone application analyses in real-time sensor and environmental data and can automatically alert the doctors and pre-assigned caregivers when a heart patient is in danger. It also transmits sensor data to a given healthcare centre for remote monitoring by a nurse or cardiologist. The project aims to have a better system that is always with patient to monitor clearly and make the record of abnormalities obtained. If we are in dangerous or unconscious condition, it alerts the user or alerts doctor or relative by making a call to family doctor or some relative. The system can be personalized and rehabilitation programs can monitor the progress of a patient. These rehabilitation programs can be used to give advice or to reassure the patient.
This document discusses pacemakers and their management during anesthesia. It begins by describing the components of the heart's conducting system and types of pacemakers. It then discusses indications for pacemakers and implantable cardioverter defibrillators. The key points regarding anesthetic management are to have the device interrogated preoperatively, monitor it closely intraoperatively, and avoid potential electromagnetic interference from devices like electrocautery or defibrillation. Regional anesthesia is usually safe but general anesthesia requires avoiding drugs that could interfere with pacemaker function.
The number of patients with implantable devices continues to grow. There are important aspects and difficulties in the perioperative management of these patients.
This document provides information about pacemaker circuits and their components. It begins by defining key terms:
- Voltage is the "push" that causes electrons to move through a circuit and is measured in volts. In pacemakers, it is provided by the battery.
- Current is the flow of electrons through a completed circuit and is measured in milliamps. It is determined by the number of electrons moving through the circuit.
- Impedance is the opposition to current flow and is measured in ohms. In pacemakers, it represents the sum of all resistance to current flow.
- These components are interdependent based on Ohm's Law, where voltage, current, and impedance influence one another
Tachycardia discriminating algorithms and trouble shooting of ICDsRaghu Kishore Galla
- ICDs use algorithms to differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in order to minimize inappropriate shocks.
- Key criteria include cycle length, stability, sudden onset, morphology matching, and AV association. Stability measures variability in cycle length while morphology compares shapes of sensed events to a template.
- Discrimination is challenging and no single criterion is perfect. Combining criteria improves accuracy, but incorrect diagnoses still occur. Programming must be tailored to individual patients and arrhythmia mechanisms.
This document discusses emergency issues related to pacemakers and implantable cardioverter defibrillators (ICDs). It covers clinical cases, device components and functions, complications, and emergency department management strategies. Key points include descriptions of pacemaker modes and indications for pacemakers, cardiac resynchronization therapy, and ICDs. Common complications like infection, lead issues, and inappropriate shocks are reviewed. The document stresses the importance of obtaining a history, physical exam, ECG, and device interrogation in the ED. Magnet use and Sgarbossa criteria for diagnosing acute MI in paced patients are also summarized.
This document discusses emergency issues related to pacemakers and implantable cardioverter defibrillators (ICDs). It covers clinical cases, device components and functions, complications, and emergency department management strategies. Key points include descriptions of pacemaker modes and indications for pacemakers, cardiac resynchronization therapy, and ICDs. Common complications like infection, lead issues, and inappropriate shocks are reviewed. The document stresses the importance of obtaining a history, physical exam, ECG, and device interrogation in the ED. Magnet use and Sgarbossa criteria for diagnosing acute MI in paced patients are also summarized.
The document discusses the history and development of cardiac pacemaker systems. It begins with an introduction to pacemakers and their purpose. It then covers the early conception of artificial pacing in the late 19th century, the invention and clinical prototyping of early pacemakers in the 1960s, and current developments including dual-chamber and rate-responsive pacemakers. The document concludes by discussing future trends, including more advanced sensors, microprocessors to allow flexible programming, and self-adjusting capabilities.
This document provides information about electrocardiogram (ECG) machines. It discusses the history of the ECG, invented in 1895 by Willem Einthoven. It describes different ways to measure ECGs, such as wireless, 12-lead, Holter monitor, and event recorder. The document explains the principles of electrocardiography and how ECGs are generated and interpreted. It outlines the operation of ECG machines, including preparing patients, placing electrodes, and interpreting recordings. Safety, troubleshooting, and cleaning/maintenance are also covered.
Diagnostic tests are used in cardiology to confirm data from a patient's history and physical assessment. Common tests include blood studies to detect cardiac biomarkers released during injury, imaging studies like echocardiograms and CT scans to visualize the heart structures, and stress tests to evaluate the heart's response to physical or pharmacological stress. Electrocardiograms are also routinely performed to analyze the heart's electrical activity. More invasive procedures like cardiac catheterization can further evaluate conditions and guide treatment. The results of diagnostic tests along with the clinical picture are important for cardiologists to diagnose and manage cardiovascular conditions.
Cardiac resynchronization therapy (CRT) involves implanting electrodes in the left and right ventricles of the heart to coordinate their contractions and improve heart function in patients with heart failure. CRT works by delivering electrical pulses that resynchronize the timing of the ventricles' contractions. Studies show CRT can improve symptoms, exercise capacity, quality of life and reduce mortality and hospitalizations in heart failure patients. CRT devices include a pacemaker or defibrillator and leads placed in the heart to deliver electrical pulses. Doctors program the devices to optimize timing between the ventricles. CRT is effective for treating ventricular dyssynchrony seen in conditions like left bundle branch block.
The document summarizes studies evaluating a subcutaneous implantable cardioverter-defibrillator (ICD) system as an alternative to transvenous ICDs. Short-term studies identified an optimal electrode configuration and found the subcutaneous ICD detected ventricular fibrillation similarly to transvenous ICDs. Larger trials implanted subcutaneous ICDs permanently in patients meeting standard ICD indications and found the devices successfully detected and treated induced and spontaneous arrhythmias. While early results are promising, larger randomized studies are still needed to compare subcutaneous to transvenous ICD outcomes.
Increase atrial and ventricular mA
6. AAI: normal atrial pacing
7. VVI: normal ventricular pacing
8. DDD: failure to sense atria; increase atrial sensitivity
9. DDD: failure to capture ventricle; increase ventricular mA
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
More Related Content
Similar to Perioperative anaesthetic management of a patient with an implanted cardiac device.pdf
- The document discusses the history and evolution of implantable cardioverter defibrillators (ICDs). Key points include:
- ICDs were first conceived in 1966 and the first human implant was in 1980.
- ICDs function by sensing cardiac rhythms, detecting arrhythmias like ventricular tachycardia or fibrillation, and delivering electrical therapies like anti-tachycardia pacing or shocks to treat them.
- Important aspects of ICD function include sensing, detection algorithms, therapy delivery, and troubleshooting problems. Studies show programming ICDs more conservatively with longer detection intervals and fewer unnecessary therapies can reduce inappropriate shocks and mortality.
This document discusses pacemakers, including their history, components, types, functions, programming, complications, and clinical management. It provides details on pacemaker technology, how they treat arrhythmias, and considerations for patients with pacemakers during medical procedures or surgery.
The document discusses cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. It covers how each device functions, their indications for use, and programming options. When providing anesthesia for patients with CIEDs, special precautions must be taken to avoid electromagnetic interference that could disrupt device function or sensing. This includes reprogramming devices if needed and monitoring patients closely during and after procedures.
This document discusses considerations for surgery in patients with implantable cardioverter-defibrillators (ICDs) or pacemakers. Electrocautery can cause electromagnetic interference that temporarily or permanently affects the device's functioning by resetting modes, inhibiting pacing, or triggering ICD shocks. The impact depends on factors like device type, lead placement, and whether the patient relies on pacing. Evaluation involves assessing the device and settings. Measures like using bipolar cautery, maximizing distance between devices and cautery, and magnet placement can reduce risks. After surgery, devices may need reprogramming and checking.
In this system Atmega controller is used to scan ECG signal and search for pattern in common range, if the pattern will be in normal range then it gives the report of being normal if it is found that it is not in normal range then the person is suffering from some kind of heart disease.
- Implantable cardioverter defibrillators (ICDs) are implanted inside the body to detect abnormal heart rhythms and deliver electrical shocks or pacing to correct life-threatening arrhythmias and reduce the risk of sudden cardiac death. ICDs continuously monitor heart rate and rhythm and can deliver low- or high-energy shocks when ventricular fibrillation or ventricular tachycardia is detected.
- ICD implantation involves placing the generator under the skin in the chest and threading leads through veins to the heart to detect rhythms. Newer dual-chamber or biventricular ICDs have additional leads. ICDs must be replaced every 5-10 years when batteries deplete,
Telemedicine System For Cardiac PatientsSharad Karwa
The aim of this project is to create a personalized heart monitoring system using smart phones and electrodes and mobile application which is capable of monitoring the health of high risk cardiac patients. The smart phone application analyses in real-time sensor and environmental data and can automatically alert the doctors and pre-assigned caregivers when a heart patient is in danger. It also transmits sensor data to a given healthcare centre for remote monitoring by a nurse or cardiologist. The project aims to have a better system that is always with patient to monitor clearly and make the record of abnormalities obtained. If we are in dangerous or unconscious condition, it alerts the user or alerts doctor or relative by making a call to family doctor or some relative. The system can be personalized and rehabilitation programs can monitor the progress of a patient. These rehabilitation programs can be used to give advice or to reassure the patient.
This document discusses pacemakers and their management during anesthesia. It begins by describing the components of the heart's conducting system and types of pacemakers. It then discusses indications for pacemakers and implantable cardioverter defibrillators. The key points regarding anesthetic management are to have the device interrogated preoperatively, monitor it closely intraoperatively, and avoid potential electromagnetic interference from devices like electrocautery or defibrillation. Regional anesthesia is usually safe but general anesthesia requires avoiding drugs that could interfere with pacemaker function.
The number of patients with implantable devices continues to grow. There are important aspects and difficulties in the perioperative management of these patients.
This document provides information about pacemaker circuits and their components. It begins by defining key terms:
- Voltage is the "push" that causes electrons to move through a circuit and is measured in volts. In pacemakers, it is provided by the battery.
- Current is the flow of electrons through a completed circuit and is measured in milliamps. It is determined by the number of electrons moving through the circuit.
- Impedance is the opposition to current flow and is measured in ohms. In pacemakers, it represents the sum of all resistance to current flow.
- These components are interdependent based on Ohm's Law, where voltage, current, and impedance influence one another
Tachycardia discriminating algorithms and trouble shooting of ICDsRaghu Kishore Galla
- ICDs use algorithms to differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in order to minimize inappropriate shocks.
- Key criteria include cycle length, stability, sudden onset, morphology matching, and AV association. Stability measures variability in cycle length while morphology compares shapes of sensed events to a template.
- Discrimination is challenging and no single criterion is perfect. Combining criteria improves accuracy, but incorrect diagnoses still occur. Programming must be tailored to individual patients and arrhythmia mechanisms.
This document discusses emergency issues related to pacemakers and implantable cardioverter defibrillators (ICDs). It covers clinical cases, device components and functions, complications, and emergency department management strategies. Key points include descriptions of pacemaker modes and indications for pacemakers, cardiac resynchronization therapy, and ICDs. Common complications like infection, lead issues, and inappropriate shocks are reviewed. The document stresses the importance of obtaining a history, physical exam, ECG, and device interrogation in the ED. Magnet use and Sgarbossa criteria for diagnosing acute MI in paced patients are also summarized.
This document discusses emergency issues related to pacemakers and implantable cardioverter defibrillators (ICDs). It covers clinical cases, device components and functions, complications, and emergency department management strategies. Key points include descriptions of pacemaker modes and indications for pacemakers, cardiac resynchronization therapy, and ICDs. Common complications like infection, lead issues, and inappropriate shocks are reviewed. The document stresses the importance of obtaining a history, physical exam, ECG, and device interrogation in the ED. Magnet use and Sgarbossa criteria for diagnosing acute MI in paced patients are also summarized.
The document discusses the history and development of cardiac pacemaker systems. It begins with an introduction to pacemakers and their purpose. It then covers the early conception of artificial pacing in the late 19th century, the invention and clinical prototyping of early pacemakers in the 1960s, and current developments including dual-chamber and rate-responsive pacemakers. The document concludes by discussing future trends, including more advanced sensors, microprocessors to allow flexible programming, and self-adjusting capabilities.
This document provides information about electrocardiogram (ECG) machines. It discusses the history of the ECG, invented in 1895 by Willem Einthoven. It describes different ways to measure ECGs, such as wireless, 12-lead, Holter monitor, and event recorder. The document explains the principles of electrocardiography and how ECGs are generated and interpreted. It outlines the operation of ECG machines, including preparing patients, placing electrodes, and interpreting recordings. Safety, troubleshooting, and cleaning/maintenance are also covered.
Diagnostic tests are used in cardiology to confirm data from a patient's history and physical assessment. Common tests include blood studies to detect cardiac biomarkers released during injury, imaging studies like echocardiograms and CT scans to visualize the heart structures, and stress tests to evaluate the heart's response to physical or pharmacological stress. Electrocardiograms are also routinely performed to analyze the heart's electrical activity. More invasive procedures like cardiac catheterization can further evaluate conditions and guide treatment. The results of diagnostic tests along with the clinical picture are important for cardiologists to diagnose and manage cardiovascular conditions.
Cardiac resynchronization therapy (CRT) involves implanting electrodes in the left and right ventricles of the heart to coordinate their contractions and improve heart function in patients with heart failure. CRT works by delivering electrical pulses that resynchronize the timing of the ventricles' contractions. Studies show CRT can improve symptoms, exercise capacity, quality of life and reduce mortality and hospitalizations in heart failure patients. CRT devices include a pacemaker or defibrillator and leads placed in the heart to deliver electrical pulses. Doctors program the devices to optimize timing between the ventricles. CRT is effective for treating ventricular dyssynchrony seen in conditions like left bundle branch block.
The document summarizes studies evaluating a subcutaneous implantable cardioverter-defibrillator (ICD) system as an alternative to transvenous ICDs. Short-term studies identified an optimal electrode configuration and found the subcutaneous ICD detected ventricular fibrillation similarly to transvenous ICDs. Larger trials implanted subcutaneous ICDs permanently in patients meeting standard ICD indications and found the devices successfully detected and treated induced and spontaneous arrhythmias. While early results are promising, larger randomized studies are still needed to compare subcutaneous to transvenous ICD outcomes.
Increase atrial and ventricular mA
6. AAI: normal atrial pacing
7. VVI: normal ventricular pacing
8. DDD: failure to sense atria; increase atrial sensitivity
9. DDD: failure to capture ventricle; increase ventricular mA
Similar to Perioperative anaesthetic management of a patient with an implanted cardiac device.pdf (20)
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
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Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
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𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.ppt
Perioperative anaesthetic management of a patient with an implanted cardiac device.pdf
1. Perioperative anaesthetic management of a
patient with an implanted cardiac device
Types of CIED(Cardiac implantable electronic device)
1) Permanent pacemaker (PPM): for conduction system disturbances.
2) Artificial implantable cardioverter-defibrillator (AICD) for life threatening
arrhythmias.
3) Cardiac resynchronization therapy (CRT): for treatment of heart failure (HF).
4) Cardiac resynchronization therapy with defibrillator(CRTD): for treatment of
HF.
Indications for CIED :
Indications for pacemaker Indications for AICD:
• Symptomatic bradycardia from:
– Sinus node disease
– AV-node disease
• Long QT syndrome
• Hypertrophic obstructive cardiomyopathy
• Dilated cardiomyopathy Indications for CIED
• Prophylactic use in patients with ischemic
cardiomyopathy with: – EF ≤ 30% and NYHA class I
symptoms – EF ≤ 35% and NYHA class II-III
symptoms
• Non-ischemic cardiomyopathy with EF < 35% and
NYHA class II-III symptoms
• Ventricular fibrillation/VT from non-reversible
cause
• Brugada syndrome (RBBB with ST-elevation in V1
-V3
• Arrhythmogenic right ventricular dysplasia
• Long QT syndrome
• Hypertrophic cardiomyopathy
• Infiltrative cardiomyopathy.
Types of CIED Leads
Unipolar leads:
• Single electrode is present at the lead tip which serves as the cathode
• The pulse generator serves as the anode
• More susceptible to EMI than bipolar leads
Bipolar leads:
• Two electrodes are present at the distal end serving as cathode and anode
• Have a lower risk of EMI due to close spacing between electrodes
2. NASPE/BPEG Code for Pacemakers:
Position I
Pacing chamber
Position II
Sensing chamber
Position III
Response to
sensing
Position IV
Programmability
Position V
Multisite pacing
O = None O = None O = None O = None O = None
A = Atrium A = Atrium I = Inhibited R = Rate
modulation
A = Atrium
V = Ventricle V = Ventricle T = Triggered V = Ventricle
D = Dual (A+V) D = Dual (A+V) D = Dual (T + I) D = Dual (A+V)
NASPE/BPEG Generic Defibrillator Code:
Position I
Shock chamber
Position II
Anti-tachycardia
pacing chamber
Position III
Tachycardia detection
Position IV
Anti-bradycardia
pacing chamber
O = None O = None E = Electrogram O = None
A = Atrium A = Atrium H = Hemodynamic A = Atrium
V = Ventricle V = Ventricle V = Ventricle
D = Dual (A+V) D = Dual (A+V) D = Dual (A+V)
Sources of Interference with CIED:
A)Electromagnetic interference (EMI)with electrosurgery units (ESUs):
• Most common source of EMI
• Mono polar ESU causes EMI more often than bipolar electro cautery
• Coagulation mode (high-voltage) causes more EMI than cutting (low-voltage) mode
•Risk increases when ESU is used close to:
– Pulse generator
– Leads of ICD or pacemaker
B)EMI due to other operative equipment:
• Nerve stimulators for nerve blocks • Nerve stimulators for neuromuscular monitoring
• Evoked potential monitors (SSEP, MEP) • Transcutaneous electrical nerve stimulation
•Radiofrequency scanners used to find retained surgical instruments
• Magnetic resonance imaging • Radiofrequency ablation devices
• Extracorporeal shock wave lithotripsy • Electroconvulsive therapy
C) Mechanical interference:
• CVC guidewires may cause movement of CIED electrodes.
• Large tidal volumes. • Shivering/fasciculations.
• Vibrating bone saws during craniotomy may cause mechanical interference.
3. Risks of EMI:
1) Inhibition of pacing due to ventricular over-sensing of EMI
2) Misinterpretation of EMI as tachyarrhythmia resulting in:
• Delivery of inappropriate shocks
• Anti-tachycardia pacing by AICD
3) Direct damage to CIED altering ability to treat ventricular arrhythmias
4) Myocardial burns
5) Activation of noise reversion mode/electrical reset of device
6) Total device failure with no output
Preoperative Evaluation:
A) Focused history:
• History of:
– HTN, DM, MI – Previous cardiac surgery
– Cardiomyopathy – Peripheral vascular disease
– Valvular heart disease – Congenital heart disease
• History suggestive of pacemaker dysfunction: battery failure—
– Vertigo – Syncopal attacks
B) Focused examination:
•Assess previous cardiac disease
• Assess pacemaker function:
– Type of pacemaker: ▪ Demand: synchronous ▪ Fixed: asynchronous ▪ AICD
– Determine pulse generator (PG) status:
▪ Indication for placement ▪ History of generator events
▪ Last PG test date and battery status ▪ Number and type of leads
– Time of insertion:
▪ Electrode displacement possible within 3 months of insertion
▪ Battery failure if long term
– Irregular heart rate: Competition of pacemaker with intrinsic heart rate
– Check if pacing pulses are present and create paced beats
4. • Device interrogation:
– Patients should be examined for:
▪ Underlying rhythm
▪ Appropriate functioning of CIED
– Device interrogation of CIED should be done:
▪ Within 6 months prior to surgery for ICD
▪ Within 12 months prior to surgery for conventional pacemaker
▪ Within 3–6 months for cardiac resynchronization therapy device
• Indications for CIED interrogation:
– To disable anti-tachycardia shocks in ICDs when EMI is expected
– Disable anti-tachycardia shocks when movement may be hazardous:
▪ Intraocular surgery ▪ Intracranial surgery
– Produce asynchronous pacing in pacing dependent patient
– Increase paced heart rate in patients with bradycardia to augment CO
– Disable mechanical sensor when surgery causes mechanical stimulation:
▪ Breast surgery ▪ Cardiac surgery
• CIED reprogramming using magnet:
– Magnets may be used for reprogramming if:
▪ Response to magnet is known and effect is desirable
▪ Patient is in supine position during surgery
▪ Access to magnet is adequate:
- Magnet may be observed
- Magnet may be easily removed in case of arrhythmias
– Responses to magnet application most commonly include:
▪ Asynchronous pacing at fixed rate with fixed AV-delay for PM
▪ Suspension of anti-tachycardia detection and therapy for ICDs
– Advantages: ▪ Changes in CIED function are reversible by removal of magnet
▪May not require placement of pacing/defibrillator pads
5. – Disadvantages:
▪ Does not result in asynchronous pacing with ICDs
▪ Might fail to elicit response in obese patients
▪ May be difficult to use in:
- Lateral position
- Prone position
▪ Encroaches on surgical field if incision is close to pulse generator
•Reprogramming using programming machine:
– Useful to suspend anti-tachycardia therapy in ICDs
– Advantages:
▪ Allows change in pacing mode of ICD to asynchronous mode
▪ Prevents intrusion of surgical field by magnet
– Disadvantages:
▪ Requires trained personnel
▪ Requires transcutaneous pacing/defibrillator pads post-reprogramming
▪ Changes in CIED function are not quickly reversible
C) Cardiologists opinion of pacemaker function
D) ™Investigations:
• ECG:
– For ischemia/previous MI – Confirm pacing capture: Pacing rate > intrinsic rate
– No intrinsic rhythm: patient is pacemaker dependent
– Only intrinsic rhythm: Test pacemaker function by converting to fixed mode with
magnet.
•Chest X-ray:
– Heart size, lung fields
– Continuity of pacing leads, distal tip to be within cardiac cavity
– Location of generator – Dual/single chamber
• Serum potassium: Hyperkalemia increases pacing threshold.
•Acid base balance: May affect pacing threshold.
6. Factors Affecting Pacing Function Perioperatively
1) Electrolyte: Hypo/hyperkalemia
2) Acid base balance: Acidosis/alkalosis
3) Myocardial: Ischemia/acute infarction
4) Drugs: Digoxin toxicity, catecholamines, antiarrhythmics
5) Metabolic: Hypothermia, thyroid disturbances, hypoxia, hypoglycemia
6) Factors which increase the pacing threshold:
• Hyperkalemia • Acidosis, alkalosis • Hypoxia, hypoglycemia
•Hypothermia •Anti-arrhythmic drugs • Thyroid disturbances
Preoperative Preparation:
1) Informed consent
2) NPO orders
3) Premedication with benzodiazepines/opioids
4) Correct associated imbalances: potassium and acid base imbalances
5) If electromechanical interference (EMI) unlikely, no special precaution is needed
6) If EMI likely and CIED is a pacemaker:
• Reprogram to asynchronous mode especially when pacing-dependent:
– History of symptomatic bradycardia
– Inadequate escape rhythm
– History of AV-nodal ablation
•Suspend rate adaptive functions
•Reprogramming may be rarely done with a magnet placed over pulse generator
7) If EMI likely and CIED is an AICD:
• Suspend anti-tachyarrhythmia therapy function
• Pacing mode may be changed to asynchronous mode in pacing-dependent patients
• External pacing/defibrillator pads are placed prior to surgery
7. OT Preparation
1) Suction apparatus
2) Oxygen delivery apparatus
3) Anesthetic drugs
4) Monitors
5) Chronotropic drugs kept ready
•Atropine •Isoprenaline: 10–100 µg bolus or 0.05–0.2 µg/kg/min
• Ephedrine •Adrenaline
6) Temporary transcutaneous pacing should be made immediately available
7)External cardioverter- defibrillator kept ready
Monitoring:
1) Pulse oximetry:
•Continuous waveform display is important to detect mechanical systole
•May be used as source of heart rate as ECG may display double-sensed values
2) NIBP, urine output
3) Continuous ECG:
•Artifact filter is turned off to reduce highfrequency filtering
• Selection of diagnostic mode preferred over monitor or filter modes
• This allows display of high-frequency signals, including pacing spikes
• Pacing artifacts may be misinterpreted as QRS complexes by the ECG monitor
• This may result in display of erroneous heart rate
• This occurs more commonly with unipolar leads
4) Peripheral pulse to check cardiac output and pacemaker function
5) Invasive monitoring if indicated for surgery
8. 6) Central venous catheterization:
• Guidewire movement may cause: – Inhibition of pacemaker function– Delivery of
inappropriate shock
•Thus, CIED should be reprogrammed prior to CVC placement:
– Anti-tachycardia function suspended in ICDs
– Asynchronous mode activated for pacemakers
•Continuous monitoring of ECG and pulse oximetry is required during insertion
• Displacement of CIED lead is common during first 3 months post-insertion
• Coronary sinus lead is the most prone to displacement during CVC insertion
7) ABG for electrolytes
8) Nerve stimulator: may interfere with pacing
9) Beat to beat continuous CO monitor in HOCM
Choice of Anesthetic Technique:
A) Neuraxial blocks/regional anesthesia:
•Vasodilation may be poorly tolerated with fixed heart rate
• Avoid underhydration
• Caution during nerve blocks as nerve stimulator interferes with pacing
B) General anesthesia:
•Better preferred •TIVA is preferable when GA is used
•This is because:
– Volatile agents in general increase AV delay and pacing threshold – Sevoflurane/isoflurane cause
prolongation of QT interval
Considerations for GA in Patients with Pacemaker:
1)Placement of transcutaneous pacing/defibrillator pads:
• Placed before anti-tachycardia function of ICD has been disabled
• Allows treatment of malignant arrhythmias
•External defibrillator with pacing capability should be available
•Standard anterior-posterior location of pads preferred for left-sided CIEDs
•Anterolateral position may be used when AP position is not feasible
9. 2) Anesthetic agents:
•Anesthetic agents have minimal effect on CIED function
•Ketamine and etomidate cause myo-fasciculations which may interfere with pacing
•TIVA preferable as volatile anesthetics increase AV delay and pacing threshold
•N2O accumulates in pacemaker generator pockets
•High doses of anesthetics which exacerbate bradycardia are avoided such as:
– Dexmedetomidine – Opioids such as fentanyl
• In patients with prolonged QT-interval:
– Agents prolonging QT-interval are avoided:
▪ Haloperidol ▪ High dose sevoflurane and isoflurane ▪ Ondansetron
– This reduces the risk of polymorphic VT due to QT prolongation
•Desflurane and enflurane do not have any effect on QT interval
• Caution with succinylcholine as:
– Acute increase in potassium causes increase in pacing threshold
– Myopotentials during fasciculations may be abnormally sensed
3) Avoid underhydration as compensatory tachycardia to maintain CO is
absent
4) Considerations for diathermy/electrocautery interference:
• Risk of EMI with surgeries above the umbilicus are high
•Thus, anti-tachycardia therapy has to be suspended in above-umbilicus surgery
• Risk of EMI is negligible with surgeries below the umbilicus
•Unipolar cautery is the most common source of EMI
•Thus, it causes EMI especially in patients with unipolar CIED leads
•Therefore, use of bipolar cautery is recommended
•Ultrasonic/harmonic scalpel:
– Avoids EMI – Also facilitates coagulation of tissue with minimal EMI
• Position of return plate/electrode pad of ESU:
– Current path from ESU to pad should not cross CIED leads/generator
– Plane described by return plate and active electrode of electrocautery is perpendicular to plane
described by pacemaker and pacemaker electrode
10. • Similar considerations apply to pads of nerve stimulators and TENS
• Cutting mode (lower voltage) is used as it causes least EMI
•Smallest current intensity required for cutting is Used
•ESU is used in short bursts: one second for every 10 seconds
• Avoid using electrocautery within 15 cm of the device/lead
Considerations for GA in Patients with AICD
™
1) All ICDs have pacemakers incorporated intocircuitry
™
2) Preoperative assessment of cardiac condition
3) Cardiology opinion for:
• ICD interrogation
•Programming device to no-response mode
™
4) Preoperative preparation:
•Signals from electrocautery may be misinterpreted as dysrhythmias
•Convert AICD to no-response either by programming or using magnet
• Once converted, device will not deliver therapy secondary to misinterpretation
• Convert pacemaker to asynchronous mode sothat it is not inhibited by cautery
•Do not use electrocautery when AICD is programmed to sense and deliver therapy
•AICDs must be programmed to respond to a magnet
• Magnet will not change bradycardia related pacing parameters in the ICD
•Apply patches for external defibrillation when ICD is programmed to no response
•Ensure these pads are as far away as possible from device
• Pads not to be in same plane as device and electrodes
™
5) If PA catheter monitoring is required:
• Discuss with the cardiologist
•Document the need for PA catheter and discussion with cardiologist
• Discuss possibility of dislodgement of ICD electrodes with patient
• Maintain sterile technique, consider antibiotics before inserting lines
™
6) Continue antiarrhythmic drugs until time of surgery
11. ™
7) No clear preferences of anesthetic technique between regional/general
anesthesia
™
8) If intraoperative arrhythmias occur:
•Treat intraoperative causes to prevent recurrence
•If dysrhythmia continues and magnet has been used to create no response mode:
– Remove magnet from ICD – Allow ICD to charge and deliver a response
• If dysrhythmia continues and ICD has been programmed to no response mode:
– Reprogram ICD to deliver a response – Alternatively, use external defibrillation directly
– Place external defibrillation paddles in antero-posterior location – Deliver sufficient shock
– External pacing may be required if ICD is damaged with the shock
™
9) While transporting the patient from OR:
• Monitor patients ECG •Be prepared to deliver external defibrillation
• Interrogate and reprogram ICD when patient has entered PACU
Postoperative Care
™
A) Immediate postoperative period:
• Check pacemaker functions, if procedure involved cardioversion and diathermy
•Monitor cardiac rate and rhythm continuously •Back up pacing and cardioversion/defibrillation
capability
™
B) Postoperative restoration of CIED function:
• Use cardiologist help • Interrogate to assess function
• Reprogram appropriate setting •If CIED is AICD, restore all anti-tachycardia therapy
Treatment of Pacemaker Failure
Rate Response
Adequate to maintain BP Oxygen, airway control
Place magnet over pacemaker
Atropine, if sinus bradycardia
Severe bradycardia and hypotension Oxygen, airway control
Place magnet over pacemaker
Transcutaneous/transvenous pacing if magnet fails
Atropine if sinus bradycardia
Isoproterenol to increase ventricular rate
No escape rhythm Cardiopulmonary resuscitation Place magnet over
pacemaker
Transcutaneous/transvenous pacing if magnet fails
Isoproterenol to increase ventricular rate
12. Emergency Cardioversion/Defibrillation
™
1) Terminate all EMI sources
™
2) Remove magnet to enable defibrillation pads
™
3) Minimize current flow through pulse generator/leads
™
4) Defibrillation pads placed as far away from pulse generator as possible
™
5) Defibrillation pads placed perpendicular to major axis pulse generator/leads
™6) To extent possible, pads placed in anterior-posterior location
™
7) Use clinically appropriate energies
Complications:
™
- Failure to fire - Failure to capture
™
- Pacemaker syndrome seen with VVI mode - Pacemaker tachycardia
Special Considerations:
™TURP:
• Use harmonic scalpel • Cutting mode may cause electromagnetic interference
• Use cautery in short bursts
• Coagulation mode does not interfere • May have to convert to fixed mode if diathermy plate placed
around chest
• Possibility of random reprogramming due to EMI ™
Direct current electrical cardioversion:
• Use lowest possible energy • Paddles placed as far away from generator as possible (> 10 cm)
• Paddles placed perpendicular to line between generator and lead tip
• Follow up with formal pacemaker interrogation • Modern CIEDs are fitted with Zener diodes to
prevent damage from DC shocks
™MRI:
• During MRI a large radiofrequency signal 30–3000 Hz is generated
• This may induce lead heating of CIED up to 89°C leading to: – Myocardial thermal injury
– Changes in pacing properties: ▪ Inhibition of pacing ▪ Rapid pacing induced by radiofrequency signal
• For majority of older CIEDs, MRI is unsafe
• Many modern CIEDs have been designed to be MRI conditional
• MRI is contraindicated in pacing dependent patients
• When MRI performed: – Imaging must be performed in 1.5 Tesla magnet – CIED is interrogated
before and after the MRI
™Radiotherapy:
• Ionizing radiation used in radiation therapy may result in pacemaker damage:
– Temporary change resulting in oversensing – Reset to factory settings – Complete device failure
• ≥ 1000 rads causes pacemaker damage
• Non-neutron producing treatment is preferred to reduce risk of device reset
• Pulse generator and leads should be outside radiotherapy field
• Surgical relocation of pulse generator should be considered if EMI is inevitable
• Verify pulse generator function before and after therapy
• CIED is evaluated at weekly intervals in case of recurrent therapy
™
13. Extracorporeal shock wave lithotripsy:
• Used to treat upper urinary tract calculi
• Piezoelectric crystals for rate-adaptive pacing may be damaged by ESWL waves
• < 16 KV shock energy to be used • Do not focus lithotripsy beam near pulse generator
• Pacing mode is changed to VOO or DOO to prevent EMI from ESWL waves