Cardiac Pacemaker
Used when intrinsic cardiac electrical activity is inappropriately slow or absent
Sense electrical activity of heart and deliver electrical impulses to the heart.
Pulse generators contain:
- Battery (5-8 year lifespan)
- Output circuit
- Timing circuit
- Sensing circuit
Types of pacemaker: Pacemaker Code
| Chamber paced | Chamber sensed | Response to sensed event | Rate-responsive features | Anti-tachycardic facilities |
| Atrium Ventricle Dual |
Atrium Ventricle Dual NOne |
Triggered Inhibited Dual (Atrial triggered, ventricle inhibited) NOne Reversed |
R - rate responsive pacemaker | Pacing Shock Dual - Pacing & shock |
Insertion technique
Endocardial wiring:
- Insertion into cephalic, axillary or subclavian vein
- Advanced into atrium/ventricle
- Pulse generator placed subcutaneously
Extracardial wiring:
- Placed epicardially onto heart surface
- Used in paediatrics where wires may become too short as heart grows
Complications:
- General/insertion
- Infection
- Wound dehiscence
- Thrombophlebitis
- Specific
- Electrical problems: failure to capture, output, sense, trigger etc
Preparation
- FBC, Clotting screen
- Antibiotics: Flucloxacillin 500mg IM + Benzylpenicillin 600mh IM / 20min before, 1, 6 hours after
