CARDIAC PACEMAKERS - ELDOR CSEN Anesthesia：心脏起搏器-艾尔多国家科技教育网麻醉.ppt

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CARDIAC PACEMAKERS - ELDOR CSEN Anesthesia：心脏起搏器-艾尔多国家科技教育网麻醉.ppt

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CARDIAC PACEMAKERS - ELDOR CSEN Anesthesia：心脏起搏器-艾尔多国家科技教育网麻醉

* Examples of Rhythms Undersensing Pacemaker doesn’t sense patient’s own beat and fires (second last beat) * Examples of Rhythms Oversensing Pacemaker senses heart beat even though it isn’t beating. Note the long pauses. * Examples of Rhythms Capture Pacemaker output (spike) is followed by ventricular polarization (wide QRS). * Examples of Rhythms Noncapture Pacer stimulus fails to cause myocardial depolarization Pacer spike is present but no ECG waveform Fires but fails to capture Undersensing- Fails to sense ECG Pacer spikes after theQRS Oversensing-Fails to fire * Examples of Rhythms 100 % Atrial Paced Rhythm with 100% Capture * Examples of Rhythms 100% Ventricular Paced Rhythm with 100% Capture * Examples of Rhythms 100% Atrial and 100% Ventricular Paced Rhythm with 100% Capture * Examples of Rhythms 50% Ventricular Paced Rhythm with 100% Capture * Examples of Rhythms 25% Ventricular Paced Rhythm with 100% Capture (Note the sensing that occurs. Pacer senses intrinsic HR and doesn’t fire). * Examples of Rhythms AICD Shock of VT Converted to NSR * Examples of Rhythms * Examples of Rhythms * Examples of Rhythms DDD Pacemaker * References Moser SA, Crawford D, Thomas A. AICDs. CC Nurse. 1993;62-73. Nagelhaut JJ, Zaglaniczny KL. Nurse Anesthesia. Philadelphia: Saunders.1997. Ouellette, S. (2000). Anesthetic considerations in patients with cardiac assist devices. CNRA, 23(2), 9-20. Roth, J. (1994). Programmable and dual chamber pacemakers: An update. Progress in anes thesiology, 8, chapter 17. WB Saunders. * Have multiple Tachycardia zones with appropriate therapy Records adverse events and treatment * Transvenous optimal. With transcutaneous AV capture happens simultaneously. With esophageal, possibly only atrial capture . * Block in the conduction systems below the Bundle of His ( in the bundle branches) Right bundle branch, and anterior and posterior fascicles of left bundle branch * Chronotropic incompetence is known as a deficient rate respons