Permanent cardiac pacemakers: issues relevant to the emergency physician, part I (original) (raw)

Temporary pacemakers: current use and complications

Revista Española de …, 2004

Introduction and objective. Temporary pacemakers (TP) are used in the emergency treatment of patients with severe bradyarrhythmia. They are often used in emergency situations and for older patients in poor general condition who are hemodynamically unstable and uncooperative. The aim of this study was to review and analyze the indications, incidence, and type of complications associated with TP implanted in our center during a 6-year period. Patients and method. We analyzed significant clinical variables, indication, route of insertion, follow-up, complications, and duration of temporary pacing. Results. A total of 568 TP were implanted, and 530 cases were available for review (mean age 74.8 [11] years). The main indications were symptomatic complete AV block (51%), prophylaxis for replacement with a definitive pacemaker (14.7%), blockage in the acute phase of myocardial infarction (12.6%), bradyarrhythmia due to drug intoxication (12.2%), symptomatic sick sinus syndrome (7.5%), and long QT interval or ventricular tachycardia (2.5%). The route of insertion was via the femoral vein in 99% of the cases. The duration of TP use was 4.2 days (range, 1 to 31 days). A total of 369 patients (69.6%) required a permanent pacemaker. Complications: 34 patients died (6.4%), but only 3 deaths were attributable to TP implantation. Other severe complications were seen in 98 patients (18.5%). Malfunction of the TP occurred in 48 patients (9%) because of electrode displacement. Conclusions. Temporary pacemakers are used in older patients with extreme bradyarrhythmia and occasionally with acute myocardial infarction. Serious complications are not uncommon (22% of all patients), and can range from femoral hematoma to cardiac tamponade and even death (6%). In 9% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.

Cardiac pacemakers: Evaluation and management of malfunctions

The American Journal of Emergency Medicine, 2000

The emergency physician may be called on at any time to evaluate a patient with a pacemaker. Although current models are very reliable, malfunctions occur. This review discusses the basic components of the antibradycardic pacemaker, which malfunctions can be expected to occur, and how to evaluate an improperly functioning unit. In addition, recommendations for disposition are discussed. (Am J Emerg Med 2000;18:435-440.

A Long Term Follow-up of Patients with a Permanent Pacemaker: Necessity of Specific

2002

U ndoubtedly, the rapid technological evolution in the field of permanent pacemakers resulted both in increased reliability and functionality of the devices but also in increased obligations of the medical staff with regard to the improvement of the level of know-how and familiarization with the technical characteristics of pacemaker systems. Responsibility, clinical experience, method and specialized knowledge constitute the parameters on which the rational use and exploitation of the possibilities of the implanted device are based. Such parameters constitute the necessary prerequisites for a safe and optimal long-term follow-up of patients carrying a permanent pacemaker. However, particularly with regard to the control and programming of the permanent pacemaker, we must all admit, implant specialists, non invasive and private cardiologists, that sometimes the medical services provided do not pay tribute to the therapeutic, scientific and technical achievements. Although there 32 ñ HJC (Hellenic Journal of Cardiology)

The Role of Pacemaker Clinic in the Follow-Up of Patients with Permanent Pacemakers

The Medical Journal of The Islamic Republic of Iran, 1996

The Pacemaker Clinic at Shahid Rajai Cardiovascular Research Center rlIst started operating in August 1992. In its first year of operation, 294 permanent pacemaker patients were studied, allowing an appraisal to be carried out of the clinic's effectiveness in diagnosing and treating early complications. In the rmal analysis, pacemaker complications were observed in 68 (23%) patients, of whom 38 (56%') were treated by reprogramming the unit and without requiring any operation. The most common type of pacemaker complication observed was "under­ sensing" in 20 (29.5%) patients, followed by lack of myocardial capture by the pacemaker in 17 (25%) patients.

Approach to patients with implanted pacemaker and scheduled surgical or diagnostic procedure

Acta chirurgica iugoslavica, 2011

Application of cardiac electrostimulation in strictly defined indications has been on the increase over the last few decades. Frequent use of this therapy as well as the fact that it is applied predominantly in patients in the seventh decade of life, implies possible significant comorbidities and need for various diagnostic and surgical procedures. These are the reasons we decided to point out certain specific features in approaching this patient group in preparation and implementation of these procedures. Preoperative approach starts with usual patient history, with additional information on the type of pacemaker, last pacemaker check and electrocardiogram. This general approach is not substantialy different for pacemaker or ICD patients. What is specific is the possible interferrence caused by devices used in diagnostic or therapeutic procedures (diathermy, lithotripsy). Complications that may arise are usually related to the underlying disease rather than the pacemaker malfunctio...

Complications Related to Permanent Pacemaker Therapy

Pace-pacing and Clinical Electrophysiology, 1999

KIVINIEMI, M.S., ET AL.: Complications Related to Permanent Pacemaker Therapy JThis study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not infrequent.Elevan percent of patients needed an invasive procedure due to an early or late complication. J (PACE 1999; 22:711-720} cardiac pacing, pacemaker complications, early complications, late complications Address for reprints: fiiha Hartikainen.

Runaway Pacemaker Protection—or a Problem?

Heart Rhythm, 2013

A 68-year-old man presented with dyspnea and was found to have Mobitz II second-degree atrioventricular block. He underwent implant of a dual chamber permanent pacemaker, a St Jude Medical (SJM, St Paul, MN) Identity ADx XL DR 5386. Several months later, the patient noticed the return of dyspnea while performing yard work. He denied any recent surgery, radiation therapy, or close encounter with heavy machinery.

Implantable Cardiac Pacemakers—An Overview

International Journal of Dermatology, 1982

Since tbe development of implantable cardiac pacemakers in the early 1960s, artificial cardiac pacing has [jecome an indispensable and widely used mode of therapy for various types of cardiac arrhythmias. There are currently more than 250,000 patients with cardiac pacemakers in the United States, and approximately 30,000 new pacemakers are implanted each year.' In view of tbese numbers, it is not surprising that physicians other than cardiologists frequently participate in the management of patients with implanted pacemakers. Knowledge about cardiac pacemakers, therefore, should be of interest to cardiologists and non-cardiologists alike. The purpose of tbis paper is to: (1) give a brief historical review of cardiac pacing and pacemaker development, and describe the functional characteristics of most commonly used modern pacemakers; (2) outline current indications for cardiac pacing; (3) describe nonelectrical complications of pacemaker therapy; (4) comment on drugs and physical factors which may affect pacemaker function; and (5) discuss techniques used for the evaluation of pacemaker function. History of Cardiac Pacing and Description of Modern Pacemaker Systems Historical Perspective The clinical importance of sudden slowing in heart rate was recognized by Morgagni in the eighteenth century, and the clinical entity of sudden loss of consciousness secondary to paroxysmal heart slowing was described later by Adams and Stokes.'^"'* This disorder, which carried a mortality of approximately 50% per year,'* was the primary impetus for the development of cardiac pacemakers. As early as 1882, Von Ziemssen reported cardiac pacing for brief periods of time by precordial stimulation with intermittent intense current.^ In