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

2. 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

3. 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

4. Pulse Generator and leads

5. 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)

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

7. 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

8. Total AV Block

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

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

11. Cardiac Tamponade due to perforation

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

13. Intermittent under-sensing of ventricular impulse

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

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

16. 12-lead EKG biventri-cular capture.

17. RV pacing

18. A sensed and V paced

19. A pacing V sensing
? Cari

22. Prosedur Implantasi PPM
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