how to follow up a patient with a pacemaker
TRANSCRIPT
How to follow up a patient with a pacemaker?
Yasmeen KamalTanta Rhythm Group
1 -Remote monitoring
•Trans Telephonic
•Via Internet
2-PaceMaker Clinics
Remember You are checking on a patient Not a software
Remember Samanatha?
Recommendations for Permanent Pacemaker Services
According to Canadian recommendations
2011
Resource Requirements for Pacemaker Clinics
Human Resources:
Medical Director or Most Responsible Physician (MRP)
Pacemaker Follow-up Physicians
Registered Nurses and Allied Health Professionals
Documentation and Database Requirements
Equipment Resources
EchoCardiography , Exercise ECG , Tilt table test , up to EP unit
Content of Follow-up
Four Categories of Pacemaker-Monitoring Goals according to:
HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs) 2008
1-Patient-related
2-PaceMaker related
3-Disease related
4-Communication related
History and physical examination
Don’t forget to check on Wound
Every Visit
Be aware of: Late device infection!!!!
History of cerebro vascular insult .. AF??
Chest pain
HF symptoms
Dizziness or syncope
edema or pain on the pacemaker sided limb
Palpitation
others
12 Lead ECG
The Pacemaker ECGs are illustrated in separate lecture
Note that : The ECG is Your best friend
You can know a lot about the pacemaker functions only from the ECG
Cherchez Le “P”
Chest X-ray
•Lead position
•Lead Fracture
•Other associations
Apply a Magnet
•Asynchronous pacing on applying the magnet at magnet rate ”VOO , DOO”
•The magnet rate usually differs from the ususal programmed rate•According to the manufacturer
•Reflects the status of the battery
•Some devices allow the magnet response to be programmed on & off
USE The Programmer
Match the programmer head with the pacemaker and wait for interrogation
Start interrogation
Place the programmer head over the device
Medtronic
Boston
Saint JudeBitotronik
1-capture Threshold voltage measurement“at certain pulse width”
Remember the strength duration curve
Make sure that the safety margin is adequate
DON’T RELY ON EGM
2-Sensing thresholdMeasure intrinsic P and R wave endocardial signals
Adjust sensitivity
3-Lead impedance
Compare Results with previous data
Check programmed data “ output , sensitivity , hysteresis , base rate ,
UTR , PVARP , AMS , autocapture”
That was the measured data
Take a look on the memorized data
Remote monitoring
Take Home messages
1. You are a cardiologist and you have patients at the follow-up clinic , not smart phones
2. Collect and compare data
3. The 12 Lead ECG remains your best friend
4. Don’t trust the EGM alone
5. Devices are smart but you are smarter
Lots of data you obtain about patients lives from their devices
Does it feel good to share your life details with somebody?
Thank you