Download - Pacemaker ECGs. Yasmeen Kamal
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PACEMAKER ECGs
Presented By:Yasmeen Kamal
Tanta Rhythm Group (TRG)
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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 ?
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A 12 Lead ECG is made , what can you see ?
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In order to reach a proper diagnosis , you should fulfill the following points
1. Mode of Pacing2. Rate3. Capture function4. Sensing function5. What is the underlying
rhythm?6. What to do next?
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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.
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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
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North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group
Modes of pacing
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Another Example of paced ECG
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Mode :Here , We can see 2 spikes.One preceding the p wave and the other is preceding the R wave and pacing is sequentialSo 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
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The underlying Rhythm :It is probably Bi-nodal disease
What to do next?Check the sensing function using the programmerBy lowering both atrial and ventricular rates
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So what about this strip?
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What about it!!
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There are pacemaker spikes followed by atrial activity. There is association between each paced atrial activity and Intrinsic ventricular activityMode 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 pacingIf DDD you should test ventricular captureAnd atrial sensing should be assessed in either modes
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DDDAS – VPCapture : ventricular capture is appropriatesensing : Atrial sensing function is appropriateUnderlying rhythm : AV nodal diseaseWhat to do next? Check ventricular sensing by prolonging AV delay
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Explain those beats
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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
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Paced beatFused beatIntrinsic
“capture” beatPseudo fusion
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Mode : DDDCapture :Appropriate in both chambersSensing Function : ok regarding both chambers
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Explain this?
Hysteresis Function
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Is their Anything wrong?
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Take a Quick LOOK at V1
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PaceMaker Malfunction
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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 muscleOversensing Leads to Underpacing
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The pacemaker fails to generate an impulse
What is called “Failure of output”
Ventricular Oversensing
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Undersensing
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Failure of Capture
Spikes not followed by ventricular eventsPseudo fusion beats “3rd and 5th from lt”
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Pacemaker mediated Tachycardia
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PMT Initiated by atrial non capture
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A strip is taken from a Patient with VVI pacemaker while interrogating the device
Explain?
Magnet Mode Behavior acting temporarily like VOO
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Automatic Mode Switching
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Any Questions?
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Thank You