Pacemaker Implantation

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Pacemaker Implantation

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Pacemaker Implantation

• Pre-implantation
• Clinical assessment of patient
• Age
• Symptons
• Underlying cardiac rhythm
• Underlying medical state
• Size
• Evaluation of daily living activities
• Future needs

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Pacemaker Implantation

• Temporary pacing
• Access - Subclavian
• - External / Internal jugulars
• - Femoral
• - Brachial
• - Surgical (epicardial)
• Emergency Pacing - Oesophageal
• - Transthoracic
• - Transcutaneous

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Pacemaker Implantation

• Permanent pacing
• Access - Subclavian
• - Cephalic
• Lead / Implantable Pulse Generator (IPG)
  placement site
• Dominant side / patient activities
• Anatomy / venous access
• ? Previous intervention / infection
• Concommitent therapy ... surgery / ICD
• Experience of operator

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Access - Blood Vessels
1 - Anatomy 5
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Access - Cardiac Chambers
1 - Anatomy 6
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Pacemaker Implantation

• Implantation analysis
• 3 lead ECG monitor / recorder
• chest lead - unipolar Electrogram (EGM)
• Electrophysiology amp - bipolar EGM
• Pacing system analyzer (PSA)
• Documentation
• patient demographics
• medical history
• IPG data
• other implant data

Cont/.....
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Pacemaker Implantation

• Implantation analysis cont/.....
• Sterile connector cables
• IPG programmer software
• Magnet
• Sterile accessories
• Spare batteries, connectors etc.

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Pacemaker Implantation
Signal Amplitude / Slew Rate
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Pacemaker Implantation
Signal Frequency
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Pacemaker Implantation

• Measurements
• 1.Sensing threshold
• Amplitude (Minimum P - 2mV , R - 5mV)
• Slew rate
• Frequency content
• Duration

Cont/.....
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Pacemaker Implantation

• Measurements
• 2.Pacing threshold
• (Measured amplitude at various pulse widths)
• Paced rate gt 20 ppm above spontaneous rate
• Decrement variable output Threshold lt 1V _at_
  0.5ms
• Impedance measurement 300 - 1000 ohms
• .... calculated / displayed
• Intracardiac electrogram
• .... PSA
• .... ECG machine
• .... Monitoring system

Cont/.....
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Pacemaker Implantation

• Measurements
• 3.Lead stability
• 1V output, or 2X diastolic threshold (min. 1V)
• 10V output for diaphragm stimulation test
• Lead sutured in position
• Re-measure sensing / pacing characteristics
• Dual-chamber system
• - Measure Retrograde Conduction Time
• - Adjust PSA mode
• Interrogate / Optimise IPG
• Confirm labelling information

Cont/.....
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Pacemaker Implantation

• Measurements
• 4.Lead Connection
• Lead attached to IPG, setscrew tightened and
  sealed with cap
• IPG inserted
• Ascertain correct sensing / pacing function of
  system. Apply magnet if required.
• Complete all documentation
• - pacemaker clinic / hospital records
• - manufacturers file / central database

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Implant Workshop