What steps will you take to diagnose the underlying cause of this patient’s recurrent syncopal episodes? IntroductionĬardiac pacemakers have evolved from singlechamber devices that deliver a fixed pacing rate to multichamber systems with programmable features that preserve and more closely mimic normal cardiac electrophysiology. The cardiac monitor shows pacing artifacts that are completely dissociated from QRS complexes. She is normotensive and her heart rate is 48 beats/min. She tells you that this is the third time she has fainted in the past 24 hours. She has cardiac sarcoidosis and has a DDD pacemaker that was implanted 6 months ago. What are your critical actions?Ī 38-year-old woman who fainted in the grocery store is wheeled into the last unoccupied room in your ED with a cardiac monitor. A prior ECG shows a paced rhythm and narrower QRS complexes. On the cardiac monitor, you see extremely wide QRS complexes following pacer artifacts and intermittent pauses where pacing artifacts appear alone. Her temperature is normal, her blood pressure is 86/40 mm Hg, and her heart rate is 42 beats/min. Case PresentationsĪn ill-appearing 74-year-old woman is brought in on a stretcher by EMS personnel who broke down her door to find her slumped on her couch. Finally, a basic approach to implanted cardioverter-defibrillator devices (which often accompany pacemaker devices) is presented. Potential sources of electromagnetic interference and special considerations pertaining to the cardiac resuscitation of patients with implanted cardiac devices are reviewed. The electrocardiographic diagnosis of hyperkalemia and acute myocardial infarction in paced rhythms is also discussed. This review summarizes current indications for permanent pacing, reviews epidemiologic data relevant to implant complications, and describes a clinical approach to the patient with potential pacing malfunction. Despite greater experience in implantation and improved device sophistication, patients continue to face complications associated with hardware implantation and device malfunction. The use of implanted pacemaker devices is increasing worldwide, owing to technological advances, new indications, and an aging population. Electrocardiogram Appearance of Pacemaker Failure Radiograph Of Dual-Chamber, Biventricular Pacemaker/Implantable Cardioverter-Defibrillator Systemįigure 5. Electrocardiogram Tracing Of Myocardial Infarction, Paced Rhythmįigure 4. Electrocardiogram Tracing Of Paced Rhythms In The Setting Of Severe Hyperkalemiaįigure 3. Indications For Permanent Pacingįigure 2. Clinical Applications Of Magnet On Implanted Cardiac Deviceįigure 1. Expected Response To Magnet Placement Over PacemakerImplantable Cardioverter-Defibrillator And Clinical Implications Of Different Magnet Responses Causes Of Pacemaker Malfunction%2C By Category Radiographic Assessment Of The Permanent Pacemaker/Implantable Cardioverter-Defibrillator Indications For Cardiac Resynchronization Therapy The North American Society For Pacing And ElectrophysiologyBritish Pacing And Electrophysiology Group Generic Pacemaker Code American College of CardiologyAmerican Heart Association Classification Of Recommendations And Level Of Evidence Risk Management Pitfalls For Implantable DevicesĬlinical Pathway For Emergency Department Management Of Multiple.Management of Pacemaker-Related Complications and MalfunctionsĪpproach To The Pacemaker Patient With TachycardiaĪdvanced Cardiovascular Life Support In Patients With Pacemakers Or Implantable Cardioverter-DefibrillatorsĪpproach To The Pacemaker/Implantable Cardioverter-Defibrillator Patient Who Receives A Shock Neurocardiogenic Syncope And Carotid Sinus Syndrome Chronic Bifascicular Or Trifascicular Block
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