How to identify pacemaker?

From Heart Rhythm 2011;8:915-922.

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Telephone numbers for manufacturers to identify the pacemaker:

Medtronic: 1-800-Medtronic (1-800-633-8766)

St Jude Medical: 1-800-PaceICD (1-800-722-3774)

Boston Scientific: 1-800-Cardiac (1-800-227-3422)

Sorin Gp (ELA): 1-800-352-6466

Biotronik: 1-800-547-0394

Note: The telephone numbers are different, to call the representative to come and interrogate the pacemakers.

ICU: Postoperative AV block - Recovery

Study period: 1991-4. Boston Children's Hospital. n=2698 surgeries (73% on bypass).

Overall incidence of AV block was 3% (n=54).

Common diagnoses associated with development of AV block were VSD, Tetralogy, LVOTO repair, L-TGA and others. 

32 recovered conduction in 30 days after surgery (Graph below shows the postop. day at which conduction recovered in these 32 patients). 

9 did not recover conduction in 30 days after surgery. 

Weindling SN., et al. Duration of complete atrioventricular block after congenital heart surgery. Am J Cardiol 1998;82:525-527.

Quiz: EKG, Postop. Repair of AVSD

5 mo old, Postop. day 3 after AVSD repair.
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1) What is different between first half and second half of the EKG trace?

2) What type of pacing is being done?

3) What is the pacing rate?

4) What is the atrial rate?

5) What is the native ventricular rate?

6) What is the diagnosis for the underlying rhythm?

EKG Quiz: Pacemaker

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Assuming the pacemaker is working appropriately, guess the pacemaker mode and set-rate.

Comparison of atrial rate to paced rate holds a clue to the answer.

What could be the indication for pacemaker?

What are the reasons for a 17-yr old to have this mode of pacing?

Pacemaker - Non-capture

Attempt to detect the underlying rhythm. (Postop. patient)
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ICU: DDD pacemaker

This is 2 year old postop. patient with DDD pacemaker. What a sinking feeling one gets upon seeing this! (Absolutely no capture of either the atrium or the ventricle).
Click on the image for a larger image.

Quiz: Temporary Pacemaker

2 year old, s/p heart surgery for complex congenital heart disease - having a difficult postoperative course. Upper panel shows a problem with pacemaker. This h been corrected in the lower panel.
1) What is the pacemaker problem in the upper panel? Can you guess the pacemaker mode in the upper panel?
2) What adjustments in the pacemaker will rectify the problem?
3) Lower panel (recorded 2 hrs later): How is the pacemaker functioning now? What are the current settings in the pacemaker i.e. Mode, Rate & AV interval setting?

(Click on the image to see a larger image)

ICU: Pacemaker Settings Record Sheet

For bedside use Click here for a copy

Pacemaker Interrogation - Contact telephone numbers

Medtronic – 800-328 2518
St. Judes Medical – 800-722 3423
Biotronik – 800-547 0394
Intermedics (Guidant/Boston Scientific) – 800-231 2330
Sorin group 800-352-6466

Other: x44505, Pager 22212
Telephone numbers to identify which pacemaker a patient has are provided in a different posting in this blog.

ICU: Permanent Pacemaker

3 yr old, Heterotaxy, s/p Fontan procedure. s/p Permanent pacemaker for sick sinus syndrome. Develops sepsis, returns from percutaneous drainage of pyonephrosis. Dexmedetomidine and ketamine were used for this short interventional radiology procedure. After return to ICU, the child has the following trace on the monitor. Interpret.

1) What is the underlying rhythm?
2) What is the pacemaker set at? Guess the mode and rate.
3) Is there native AV conduction? If yes, what is the native AV interval?
4) What is the AV interval for paced beats?
5) What is the pacemaker doing? What is the final assessment of this patient?
6) Why do the pacing spikes appear irregular?
7) How would you manage this patient? (Further studies tests and evaluations are necessary to make an assessment and management).

(Click on the image to enlarge)

Quiz: EP - Apparent Malfunction of Pacemaker

1 yr old boy, s/p Mitral Valve replacement, Postop. AV block. Epicardial DDD pacemaker. HR range is set at 110-180 bpm.
First panel (24-hr trend) shows pacemaker heart rate decreased to ~110 bpm between 6pm & 10pm, when the patient was febrile.
Second panel shows EKG prior to drop in HR.
Third panel shows EKG during the low HR at ~110 bpm (with fever).
Fourth panel shows EKG after return of HR to higher level (after fever).
Fifth panel shows current EKG at the time of review (next day).

1) What are the possible reasons for the pacemaker not to respond appropriately during a time of need (fever)?
2) What further information is needed regarding pacemaker settings to determine the cause of this pacemaker behavior?
3) What change, if any need to be made in the pacemaker settings?

Pacemaker Timing Cycles - PPT

Click on the link below for a slide set on this subject:
Pacemaker Timing Cycles PPT Pacemaker Implantation Pacemaker Implantation Guidelines Pacemaker Implantation Surgery: SlideWorld Medical PPT Search Engine

ICU, EP: DDD pacemaker

8 month old girl s/p Repair of AVSD. Permanent pacemaker (DDD) has been placed for postoperative A-V block. Currently, admited for respiratoy distress. Interpret this ICU monitor trace.

ICU: Temporary pacemaker, DDD mode, Wenckebach

DDD pacing is on for 3rd degree AV block (Postop).

There is Wenckebach phenomenon noted.

What parameter is to be checked/adjusted if we want 1:1 conduction?

EP & ICU: Concept of PMT & PVARP

10 mo. old s/p Rastelli for DORV, d-TGA, PS. 3rd deg. AV block. Fig 1: Patients monitor. Fig 2 &3: Temp. pacemaker settings. Pacemaker is set at 100 bpm. On the monitor, it is A-sensing & V-pacing at 133 bpm. Is the pacemaker working properly?

When I attempted to increase upper rate from 140 bpm to 145 bpm, this "warning" came up. What does that mean?

If I really wanted to go up in the upper rate, what are my options to get around the "warning"?

Related questions: What is PVARP? What is PMT? How do you determine the optimal PVARP? (What is retrograde VA conduction time?)

ICU: Temporary pacemaker

10 mo old with DORV, d-TGA and Pulmonary stenosis. s/p Rastelli. Postop. day 2. Underlying rhythm was 3-degree AV block. Temp. pacemaker is set at DDD mode. What is the pacemaker doing? Is it working properly or not?

EKG: Pacing, Interpret this.

What type of pacing is used here?
What do you think is the underlying rhythm?

ICU: EKG strip. Interpret this...

Interpret this.
3 yr old child
Modified Konno Procedure
Immediate postop.

What is the mistake?

Infant, s/p Repair of AVSD (Postop. day 8)
Postoperative Heart Block
Temporary pacemaker setting: DDD @ 90 bpm.
What is the mistake made by the nurse? (or the resident, or the fellow...attending would not have done it!!)

ICU: Temporary Pacemaker