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Pacemaker Strips

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18 views3 pages

Pacemaker Strips

Uploaded by

karan Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Analyzing Pacemaker Strips: a systemic

approach in the textbook Chap 10


Step One:
• identify the patient's own beats
• Place an index card above two consecutively paced beats
• Mark the automatic interval. “Left mark” and “right mark” on the
index card.
• The automatic interval measurement will assist you in determining
if the pacemaker fired on time, too early, too late or not at all

Step two:
• Starting on the left side of the strip, analyze each pacing spike you
see
• The patient’s intrinsic beats do not need analyzing, but you need to
be able to identify them from the paced beats

Analyzing Pacemaker Strips: a systemic


approach in the textbook
Step three:
• Identify the pacing spike to be analyzed (only analyze one spike at a time)
• Using the marked index card, place the left mark on the spike of the paced
beat or R wave of native beat immediately preceding the pacing spike
being analyzed

Step four:
• Observe the relationship of the right mark with the spike being analyzed
to determine the answer
• Spike occurs on time: Ventricular capture beat(normal), fusion
beat(normal), pseudofusion beat(normal), failure to capture(abnormal)
• Spike doesn’t occur-Failure to fire (abnormal)
• Spike occurs too early- Undersensing (abnormal)
• Spike occurs too late- Oversensing (abnormal)
Pacemaker Mediated Tachycardia
PMT
PMT is a form of re entry tachycardia that can occur in patients who have a
dual-chamber pacemaker (DDD).
PMT is a condition where the pacemaker paces the ventricles at rates that are
inappropriately fast. It is a complication of dual chamber pacemakers.
Causes:
Any event inducing AV desynchronization may trigger PMT including:
• PACs and PVCs that trigger retrograde conduction that can be detected by
the atrial lead of the pacemaker
• Extended AV delays
• Loss of atrial sensing and/or capture

Abu-haniyeh, A. & Hajouli, S. (2020, July 26). Pacemaker mediated


tachycardia. https://www.ncbi.nlm.nih.gov/books/NBK560831/

Pacemaker Mediated Tachycardia


(PMT)
What is PVARP: post ventricular atrial refractory period (PVARP). After
an R wave is either sensed (from spontaneous ventricular activation
or paced by the device), the atrial lead cannot sense any electrical
activation in the atrium for a prespecified period of time.
• PMT results from retrograde conduction of a ventricular beat (PVC)
through the AV node.
• When retrograde conduction of this ventricular beat takes place,
the resulting earlier than normal atrial activation is sensed by the
atrial lead, specifically if the atrial refractory period (PVARP) is
passed. This earlier sensing of the P wave subsequently leads to
ventricular activation with subsequent ventricular pacing after the
set period of AV delay. If the retrograde conduction persists, a
reentrant circuit will form with continuous ventricular activation
resulting in PMT.
Diagram of a rhythm strip is in BB (PMT section).
Symptoms & Treatment
PMT in patients experience palpitations, lightheadedness,
syncope, worsening of HF or chest discomfort. HR is
usually 100-150.
Treatment:
• Reprogram the pacemaker by lengthening the post
ventricular atrial refractory period (PVARP) so that the
pacemaker ignores atrial events occurring shortly after
ventricular events.
• Applying a magnet switching to asynchronous pacing
mode
• Carotid sinus massage or use AV nodal blockers like
Digoxin, beta blockers & calcium channel blockers

Implantable Cardioverter
Defibrillator (ICD)

Heart and Stroke. (). Implantable cardioverter defibrillator


(ICD). https://www.heartandstroke.ca/heart-
disease/treatments/surgery-and-other-procedures/implantable-
cardioverter-defibrillator?gclid=Cj0KCQiA-
rj9BRCAARIsANB_4ABxRxEpBnKjfKqSF5nU2jof_uilBWkITGznURvu
E-SlWwf62GtQl9YaAlwkEALw_wcB&gclsrc=aw.ds

Al-Jefairi, N. & Burn, H. (2014). Relevance of guideline-based ICD


indications to clinical practice. Indian Heart, 66(Suppl 1), S82-
S87. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237301/

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