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Pacemaker troubleshooting

Mahmadulla Razi, Amit Madaan, Amit Goel, Santosh Kumar Sinha
Persistent left superior vena cava (PLSVC) with absence of right SVC (isolated PLSVC) is a rare congenital anomaly that occurs as a result of a degenerative condition in the left anterior cardinal vein. It is generally an incidental finding while performing invasive procedures such as antiarrhythmic device implantation. We report on a rare case of permanent pacemaker implantation in a patient with this anomaly from right subclavian route, albeit most of the earlier reported cases are from left subclavian approach...
April 2016: Avicenna Journal of Medicine
Jacques Rizkallah, William Kent, Vikas Kuriachan, John Burgess, Derek Exner
BACKGROUND: The use of cardiac implantable electrical devices continues to increase with the validation of new beneficial indications. While the risks of device implantation decreased significantly over time, significant risk remains associated with their extraction when indicated. A high-risk pacemaker lead extraction case is described, wherein a chronically implanted lead that had perforated the right atrium was successfully removed without the need for cardiopulmonary bypass. In this report we share our approach to this challenging extraction case and describe an infrequently utilized off-pump hybrid technique that we term the "lead-inverting stitch"...
2015: BMC Research Notes
Jacques Rizkallah, John Burgess, Vikas Kuriachan
BACKGROUND: Venous anomalies of the thorax can occur in isolation or in association with complex congenital heart disease. The incidence of an absent right superior vena cava in the setting of a persistent left superior vena cava is very rare in the general population with only a dozen cases documented in the medical literature. Such venous anomalies can make for very challenging electronic cardiac device implantation. We report our challenging dual chamber pacemaker implant in a patient with such complex anatomy and focus on our implantation technique that helped achieve adequate lead positioning...
2014: BMC Research Notes
K L Venkatachalam
The number of patients receiving pacemakers and defibrillators has grown substantially over the last 20 years. In addition, the complexity and sophistication of these devices have increased, making diagnosis of pacemaker problems using the electrocardiogram (ECG) more difficult for clinicians in the emergency department. This article will focus on a few of the pitfalls to be avoided when interpreting paced ECGs. Pacemaker algorithms designed to minimize right ventricular pacing may be confused with pathologic failure to output...
November 2011: Journal of Electrocardiology
Fadi Mansour, Ana Martin Arnau, Jose Maria Tolosana, Lluis Mont
Knowledge of the available sensing polarities in biventricular pacemakers is necessary for appropriate troubleshooting and avoiding possible pitfalls of cardiac resynchronization therapy programming, as illustrated through this case presentation.
March 2011: Pacing and Clinical Electrophysiology: PACE
Peter Skippen, Shubhayan Sanatani, Norbert Froese, Robert M Gow
OBJECTIVE: To summarize the practical operation of temporary pacemakers in common use pertinent to the intensivist caring for the postcardiac patient. Pacemaker therapy is commonly required in the postoperative period after congenital cardiac surgery. DATA SYNTHESIS: Monitoring the hemodynamic status and availability of equipment for resuscitation is always important in any patient requiring a temporary pacemaker. Two important scenarios to consider in the pediatric intensive care unit are: 1) the patient in whom pacing has been initiated to optimize cardiac function; and 2) the patient without demonstrable spontaneous electrical activity or with extreme bradycardia...
January 2010: Pediatric Critical Care Medicine
Michael C Giudici, Darryn W Tigrett, Jacqueline I Carlson, Terri D Lorenz, Deborah L Paul, S Serge Barold
BACKGROUND: The electrocardiogram (ECG) patterns during pacing from the great cardiac vein (GCV) and the middle cardiac vein (MCV) are not well known. METHODS: We recorded 12-lead ECGs during GCV and MCV pacing in 26 patients undergoing implantation of a cardiac resynchronization device. The left ventricular (LV) lead was passed down the GCV (n = 19) or MCV (n = 7) prior to moving it to a lateral or posterolateral vein for permanent implantation. RESULTS AND CONCLUSIONS: Pacing within the GCV resulted in a left bundle branch block (LBBB) morphology with no or minimal R-wave in V(1) in 14 patients and a right bundle branch block (RBBB) pattern (R > S in lead V(1)) in four patients...
November 2007: Pacing and Clinical Electrophysiology: PACE
Julia H Indik
No abstract text is available yet for this article.
August 2007: American Journal of Medicine
M C Reade
The first part of this two-part review discussed the indications for various types of epicardial pacing systems and an overview of the routine care of a pacemaker-dependent patient. Dual chamber temporary pulse generators now feature many of the refinements developed initially for use in permanent pacemakers. Few of these are utilised in the immediate postoperative period, often solely due to lack of familiarity with all but basic functions. The second part of the review deals with the selection of pacing modes...
April 2007: Anaesthesia
Irene H Stevenson, Harry G Mond
Pacemaker diagnostics can be useful to troubleshoot both during life and after death. A 58-year old man with a single chamber ventricular pacemaker and a previous His bundle ablation died suddenly. Interrogation of his pacemaker revealed the cause of death not as pacemaker malfunction, but a fatal ventricular arrhythmia.
June 2006: Pacing and Clinical Electrophysiology: PACE
Fadi Mansour, Mario Talajic, Bernard Thibault, Paul Khairy
No abstract text is available yet for this article.
May 2006: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Juan M Aranda, Gregory W Woo, Richard S Schofield, Eileen M Handberg, James A Hill, Anne B Curtis, Samuel F Sears, J Sean Goff, Daniel F Pauly, Jamie B Conti
Cardiac resynchronization therapy (CRT) is an established adjunctive treatment for patients with systolic heart failure (HF) and ventricular dyssynchrony. The majority of recipients respond to CRT with improvements in quality of life, New York Heart Association functional class, 6-min walk test, and ventricular function. Management of HF after CRT may include up-titration of neurohormonal blockade and an exercise prescription through cardiac rehabilitation to further improve and sustain clinical outcomes. Diagnostic data provided by the CRT device may help to facilitate and optimize treatment...
December 20, 2005: Journal of the American College of Cardiology
Jennifer Woodruff, Liza A Prudente
There are currently more than 3 million patients worldwide with implanted pacemakers, and indications for implants are expanding. Pacemakers today are smaller (23-30 g) and fashioned in a more physiologic shape so as to be less obtrusive. They are replete with sophisticated diagnostic and programming features that make troubleshooting of complicated arrhythmias easier. Advanced nurse clinicians need to have a basic understanding of pacemaker function, indications for implantation, an awareness of potential complications, and facility with basic troubleshooting...
July 2005: Journal of Cardiovascular Nursing
Ray Nielsen
No abstract text is available yet for this article.
March 2004: Biomedical Instrumentation & Technology
David L Scher
PURPOSE OF REVIEW: The purpose of this review is to provide an update on stored diagnostic information furnished by new model pacemakers and implantable cardioverter-defibrillators (ICDs). This information provides crucial information about both device function and arrhythmias discovered with device interrogation and is invaluable when troubleshooting problems with devices. RECENT FINDINGS: The most recent generation of pacemakers and ICDs provides extensive diagnostic data regarding both device and lead function...
January 2004: Current Opinion in Cardiology
Enis Oguz, Ahmet Akyol, Ertan Okmen
This case report describes a patient with biventricular pacemaker in whom a far-field sensing of left atrial activity by the pacemaker's ventricular channel resulted in ventricular pacing inhibition. Placing of the left ventricular pacing electrode in the proximal part of the coronary sinus tributary resulted in this far-field sensing problem, which was resolved following decreasing the ventricular sensitivity. The authors suggest that the far-field sensing of the left atrial activity should be kept in mind for troubleshooting of an atrio-biventricular pacing system...
October 2002: Pacing and Clinical Electrophysiology: PACE
Logan Kanagaratnam, Stephen Pavia, Robert Schweikert, Nassir Marrouche, Cathy Lam, Miguel Abreu, Elizabeth Ching, Mina Chung, Walid Saliba, Mark Niebauer, Bruce Wilkoff, Patrick Tchou, Andrea Natale
Biventricular ICDs may offer increased benefit for patients with severe congestive heart failure and ventricular arrhythmia. Currently there are no approved dedicated biventricular ICDs available. Twenty-one consecutive patients who had approved nondedicated hardware implanted for biventricular pacing and defibrillation were included in this study. All device therapies were evaluated using stored electrograms. During mean follow-up at 13 +/- 7 months, 8 (36%) patients had inappropriate shocks. Ventricular fibrillation therapy was delivered for slow ventricular tachycardia because of double counting in two patients...
July 2002: Pacing and Clinical Electrophysiology: PACE
J P Moak, B Gunderson, V Freedenberg, C Ramwell
Asymptomatic dysfunction of cardiac pacing systems is not uncommonly detected using long-term ambulatory monitoring techniques. We report two patients with atrial and ventricular sensing abnormalities noted only on Holter monitoring. Multiple empirical attempts at pacemaker reprogramming based on deductive analysis of the pacing anomaly were unsuccessful. Through the use of a new digital recording system that allowed collection of surface electrocardiographic data, intracardiac electrograms, and Marker Channel data a correct diagnosis was made (pacing lead insulation failure)...
January 2002: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Bernd Nowak, Sophie Henry, Roland Mols, Steven Maertens, Martin Coenen, J├╝rgen Meyer
BACKGROUND: Pacemaker marker annotations facilitate the interpretation of device behavior in addition to ECG recordings. However, they are only available in conjunction with a programmer. We studied the diagnostic value of a prototype Telemetry Holter Decoder (THD), providing continuous marker annotations on a conventional Holter. METHODS: The study included 20 patients with VDD or DDDR pacemakers. A 24-hour Holter was performed using the THD. Marker annotations are transmitted from the pacemaker to the THD, which transforms them into analog signals, which are recorded on one of the Holter channels...
January 2002: Annals of Noninvasive Electrocardiology
R B Shaffer
Find out how they work, how to recognize their activity on an ECG, troubleshooting tips, and what patients need to know.
November 1999: Dimensions of Critical Care Nursing: DCCN
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