1. Single Chamber Temporary Pacing Operations & Troubleshooting

2. Temporary Pacing Indications  Symptomatic sinus bradycardia  Symptomatic sinus arrest  Suppression of ventricular ectopy resulting from bradycardia  Atrial fibrillation  Bradycardia/Tachycardia syndrome Sick Sinus Syndrome (Patient Must Be Symptomatic and Documented with ECG)

3. Temporary Pacing Indications  Type I and Type II second degree AV block  Acute bifascicular or trifascicular block  Complete AV block  Cardiac arrest with ventricular asystole Heart Blocks

4. Other Temporary Pacing Indications  Overdrive ventricular pacing to suppress or prevent VEA (Ventricular Ectopic Activity)  Overdrive atrial pacing to “break” SVT, atrial flutter Drug-Refractory Dysrhythmia

5. Other Temporary Pacing Indications  Coverage for anesthesia and surgery in patients with positive cardiac history  Treatment for CHB development during surgery  Augment cardiac output post operatively Cardiovascular Surgery

6. Other Temporary Pacing Indications  SSS pacing studies to determine SA node recovery  Stress testing for Coronary Artery Disease  Electrophysiologic (EP) studies Diagnostic Uses

7. Insertion Sites Internal Jugular Vein Subclavian Vein Femoral Vein Brachial Vein External Jugular Vein

8. Lead Types

9.  Endocardial/Transvenous lead –Transvenous lead is introduced into a vein and advanced into the heart  Epicardial/Myocardial lead –An epicardial lead attached to the outside of the heart is introduced through the chest wall

10. Lead Types  Bipolar lead system –The negative and positive electrodes are in contact with the heart

11. Lead Types  Unipolar lead system –The negative electrode is in contact with the heart and the positive (or ground) electrode is located elsewhere on the body

12. Cable Connectors  Connector pins on the lead(s) must be fully inserted in the patient connector block  Observe polarity – Distal = negative – Proximal = positive  Finger tighten only – no tools!

13. Temporary Pacing Parameters  Pacing rate (heart rate)  Output/stimulation threshold  Sensitivity

14. Pacing Rate Paced Interval

15. Output  The output dial regulates the current or movement of electrons Pulse Width (ms) Output/Current (ma) Output Pulse

16. Capture Depolarization of cardiac muscle following an electrical stimulus

17. Stimulation Threshold The minimum output pulse needed to consistently capture the heart 3 mA2 mA1 mA

18. Lead Maturation 123451015 Initial x3 x2 Days Since Leads Applied Threshold Amplitude

19. Sensitivity The degree that the pacing system “sees” or senses signals, controlled by the sensitivity setting which is graduated in millivolts (mV) 1.25 (mV) 2.5 (mV) 5 (mV) Sensitivity (mV)

20. Sensitivity The lower the setting, the more sensitive the pacemaker is to intracardial signals

21. NBG Codes Chamber(s) Paced A=atrium V=ventricle D=dual (both atrium and ventricle) 1st Letter Chamber(s) Sensed A=atrium V=ventricle D=dual O=none 2nd Letter Response to Sensing I=inhibit (Demand mode) T=triggered D=dual O=none (Asynch) 3rd Letter VVI Chamber paced Chamber sensed Action or response to a sensed event

22. VVI Demand/Inhibited  Pacemaker senses intrinsic depolarization  Paces the heart when the patient’s own rate becomes slower than the pacemaker

23. Ventricular Inhibited Mode (VVI)

24. VOO Asynchronous (Fixed) Pacemaker will emit an output at a fixed rate regardless of intrinsic activity

25. Ventricular Asynchronous Mode (VOO)

26. Single Chamber Troubleshooting Process 1.Gather information 2.Identify the problem and possible cause 3.Identify the solution and carry out corrective procedures

27. Information Gathered  Patient data  Pacemaker information  Lead information  Non-invasive tools

28. Undersensing Failure of the pacemaker to sense intrinsic R-waves or intrinsic P-waves

29. Undersensing

30. Oversensing Inhibition of the pacemaker by events the pacemaker should ignore, e.g. EMI, T-waves, and myopotential

31. Oversensing

32. Loss of Capture

33. Loss of Output

34. Intrinsic BeatPaced Beat Fusion BeatPseudofusion Beat Fusion/Pseudofusion Beats Intrinsic BeatPaced Beat Fusion BeatPseudofusion Beat

35. Electromagnetic Interference (EMI) Radiated or conducted energy – either electrical or magnetic – which can interfere with the function of the pacemaker in the Demand mode (EMI) 2.5 mV Should have paced 80