Pacemaker mode

Keyword

pacemaker, pacemaker modes, code, reprogramming pacemaker, pacemaker mode chage

Pacemaker code

Ex. 1) DDD : Dual chamber(atrium, ventricle) pacing and sensing, intrinsic P wave and intrinsic QRS can inhibit pacing,

Intrinscic P wave can “trigger” a paced QRS (Trigger + inhibited)

Ex. 2) DDI : Dual chamber(atrium, ventricle) pacing and sensing, No tracking of P waves (no constant AV delay)

- never trigger an AV delay following an intrinsic P wave

Ex. 3) VVIR : Ventricular pacing, Ventricular sensing, if intrinsic QRS inhibit pacing,

sensor(s) in pacemaker are used to detect cahnges in physiologic needs and increase the pacing rate accordingly

* DDD mode is best to provide AV synchrony

* Chronic/permanent atrial tachyarrhythmias or unexcitable atrium

-> set ventricular pacing mode (AV synchrony X)

Situations Probably Requiring Pacemaker Reprogramming

• Any rate-responsive device
• Special pacing indication (HCMP, DCMP, pediatric patients)
• Pacing-dependent patient
• Major procedure in the chest or abdomen
• Special procedures (see text)
  • Lithotripsy
  • Transurethral resection
  • Hysteroscopy
  • Electroconvulsive therapy
  • Succinylcholine use
  • Magnetic resonance imaging

(generally contraindicated by device manufacturers)

Reference

Miller’s anesthesia, 8th edition, Ch.48 Implantable Cardiac Pulse Generators; Pacemakers and Cardioverter-Defibrillators, p.1467, p.1472

Further Reading

Review: Anaesthetic Management of Patients with Cardiac Pacemakers and Defibrillators for Noncardia Surgery,

Shivani Rastogi,MD, Sanjay Goel, MD, Deepak K Tempe, MD, Sanjula Virmani, DA, DNB, Annals of Cardiac Aneaesthesia 2005;8;21-32