PACEMAKER Yoga Yuniadi Program Studi D3 Teknik Kardiovaskuler Harapan Kita - UHAMKA

Overview battery-powered implantable devices that function to electrically stimulate the heart consist of a pager-sized housing device which contains a battery and the electronic circuitry that runs the pacemaker, and one or two long thin wires that travel through a vein in the chest to the heart

Pacemaker System Pulse generator Lead Titanium Lithium battery Electronic circuit Lead Connect the PG to myocardium Tip electrode and insulated wire conductor Bipolar or Unipolar Steroid eluting

Pulse Generator and leads

Basic Fuction To pace the heart in the absence of intrinsic impulses and to sense intrinsic cardiac electrical activity if present and inhibit pacing Mode of programmed operation Initials of mode letters: The first letter refers to the chamber(s) being paced (Atrium, Ventricle, or both, labeled Dual) The second letter refers to the chamber(s) being sensed or monitored for intrinsic electrical activity. The third letter refers to the response to a sensed event (Inhibit pacing output, Triggered pacing after a sensed event, or Dual response) The fourth letter represents the presence of rate responsiveness (R) The fifth letter represents special program availability (P)

Indications for Implantation Sinus Node Dysfunction Symptoms, regardless of the type of SND, justify implantation of a pacemaker SND + symptom = SSS

Indication of Implantation Heart Block 1st degree AVB : pseudo–pacemaker syndrome, as the prolonged PR interval creates an alteration in atrial and ventricular timing and synchronization 2nd degree AVB: Even in the absence of symptoms, Mobitz II or those located below the His bundle are typically treated with pacemaker implantation because of the potential for complete loss of conduction to the ventricles 3rd degree AVB = TAVB = CHB Bifasicular or Trifasicular Block

Total AV Block

Indication of Implantation neurocardiogenic syncope hypertrophic obstructive cardiomyopathy congestive heart failure and wide QRS

Complications 4 – 5% Venous Access Lead manipulation Pocket related Pneumothorax Hemothorax Lead manipulation Perforasi => tamponade Arrhythmias Pocket related Hematoma Infection (< 1%) Skin erosion

Cardiac Tamponade due to perforation

Troubleshooting PPM Problems Inappropriate Sensing Under sensing Oversensing Loss of Capture Loss of Biventricular Capture

Intermittent under-sensing of ventricular impulse

Ventricular pacing is inhibited because of oversensing of myopotentials from diaphragm resulting in asystole

Intermittent loss of capture due to microdislodgement in the early postoperative period

12-lead EKG biventri-cular capture.

RV pacing

A sensed and V paced

A pacing V sensing ? Cari

Prosedur Implantasi PPM Tugas untuk minggu depan