Pacemaker & AICD

What Do You Need To Know?

Pacemakers & AICDs

Why you need to know about them? It is cardiologist problem!

Three million people worldwide have a pacemaker. 600,000 pacemakers are implanted each year. It is not uncommon that Pts. Become obsessed after
implantation.

Its complications might lead to mortality and morbidity

Anatomy

NBG-Code

Pacemaker EKG

Complications
1.Pocket complications. 2.Malfunction.

Pacemaker Malfunction
I. Failure to pace (output) II. Failure to capture III.Problem with sensing: or

Failure to Pace
If there is an absence of pacemaker spikes despite indication to pace. Battery Lead Over-sensing / Cross talk

Failure to capture
Pacemaker spikes appears but no capture Electrolytes MI Drugs

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Under-sensing
Pacemaker discharge despite intrinsic cardiac activity Lead displacement Fibrosis MI

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Over-sensing
Inappropriate inhibition of pacing Extra cardiac muscle activity Device interference

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Case 1

Twiddlers Syndrome

68 yr. female with palpitation 3 wks. Post Pacemaker insertion.

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Case 2

Lead perforation & Tamponade

49 yr. 3 days s/p pacemaker insertion c/o SOB & palpitation with syncope Cold on touch & diaphoretic You obtained EKG which showed:

Pulse 145 Bp. 90/47

What is wrong ?
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Case 3

Pacemaker Mediated Tachycardia PMT

72 yr. male on pacer c/o chest pain & palpitation EKG:

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Magnet effect on pacemaker

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Case 4

Runaway Pacemaker

107 yr. male on pacer c/o dizziness SoB & palpitation

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Case 5
72 yr. male c/o dizziness EKG

What is your interpretation?

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Case 6

Failure to sense and capture Hyperkalemia

64 yr. lady on pacer c/o frequent syncopal attacks EKG obtained

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Cardiac action potential

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Case 6

Failure to sense and capture Hyperkalemia

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Case 7

Ventricular Pseudofusion Inferior STEMI

68 yr. lady on pacemaker c/o progressive SoB & fatigue EKG:

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Your Spot Interpretation?

A

C
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((AICDs))
Basic concepts: Success is probabilistic. Pacing and Cardioversion most of the time. Your aim treating the rhythm according to
ACLS Protocols.

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(AICD) Nomenclature

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AICD Malfunction
I. Pocket.
Pacemaker.

II. Device related.

Inappropriate vs. Appropriate function

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Case 8
47 yr. male on AICD c/o palpitation & SoB HR 300 Bp 70/38 O2Sat 86 RR 34 pt. response to painful stimuli

? Action
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Case 9
52 yr. lady on AICD C/O palpitation followed by shock / 6hr. On ED you attached her on monitor, which showed:

Interpretation ?
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Case 10
64 yr. on AICD c/o syncope, his EKG

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Magnet on AICD

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Can You Tell Me What To Do? Cardiac Arrest

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AICD
Key points:
Shock may lead to myocardial injury. ECG usually normalize within 5 to 15 minutes. Biomarkers can be elevated post therapy. Always remember, AICD = Cardiology involvement. In emergencies, treat the rhythm not the device.

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