Types of Pacemakers and their Complications

Escher, Doris J.W.

doi:10.1161/01.cir.47.5.1119

Cited by 38 publications

(6 citation statements)

References 61 publications

(15 reference statements)

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“…In high-frequency interference, inhibition may be the carrier wave or a low-frequency modulation, which brings the impulse into the physiological rate range (microwave-oven mode stirrers). The most vulnerable environment, particularly for external pulse generators, is the hospital with its diathermy, cautery, cardioversion, and electroshock therapy, monitoring equipment, electric beds, and electrical life-support equipment (Escher, 1973). Upon sensing extern al EMR, many pacemakers revert to a fixed rate sufficiently dose to their demand rate that the user would not normally detect the change (Mitchell, 1975).…”

Section: Discussionmentioning

confidence: 99%

Biological Effects and Health Implications of Radiofrequency Radiation

Michaelson¹,

Lin²

1987

140

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Section: Discussionmentioning

confidence: 99%

Biological Effects and Health Implications of Radiofrequency Radiation

Michaelson¹,

Lin²

1987

140

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“…The treatment of atrial fibrillation and flutter is more problematic in patients with synchronous pacemakers, as the upper following rate (120-160) can be too high in patients with limited cardiac reserve. Digitalis and verapamil will of course not block ventricular rate in these patients, but digitalis may change a coarse into a fme atrial fibrillation where the f-waves are not picked up by the sensing electrode, and thereby reduce ventricular rate (10).…”

Section: Discussionmentioning

confidence: 99%

Delay of Onset of Second Degree Pacemaker Block by Beta‐Blockade in Patients with P‐Synchronous Pacemakers

Storstein

1981

Journal of Internal Medicine

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ABSTRACT. Second degree pacemaker block is a safety mechanism of the synchronous pacer at atrial rates above 120–130. The aim of the present study was to determine the work level at which pacemaker block occurred before and after β‐blockade. Seven patients (mean age 53 y.) were submitted to graded, submaximal exercise on a bicycle ergometer without drug and after 0.8 mg pindolol i.v. (6 pats.) or alprenolol orally (1 pat.). Pacemaker block developed at much higher total work after β‐blockade in 3 patients (5800 vs. 1900 kpm, p > 0.0005), while 4 patients had to stop work due to exhaustion before pacemaker block occurred. Total work increased significantly after β‐blockade (p > 0.0005). Lack of a stable i.v. atrial electrode has delayed the extensive use of the synchronous pacemaker. The design of the generator, however, is not optimal as the upper escape rate at which pacemaker block occurs is too low for a number of patients. β‐Blockade effectively delays the occurrence of pacemaker block and can be of therapeutic value. It is suggested that the P‐synchronous pacer should be redesigned with a programmable basic rate (50–70 beats/min) and a programmable upper rate (130–180 beats/min) to ensure that the obvious physiologic advantages of the atrial triggered pacemaker can be maintained both at rest and during physical exercise.

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“…Atrial activity was tracked and in the absence of ventricular activity a ventricular stimulus was delivered. Further, pacemakers that are rate responsive allow for a pre-programmed adjustment to the heart rate [18]. Our patient had a rate responsive pacemaker, which is advantageous for patients with chronotropic incompetence because of its ability to increase rate in response to exercise, which becomes more vital as the pregnancy advances.…”

Section: Pacemaker Technologymentioning

confidence: 97%

“…Sensors for rate modulation are incorporated in the pacemaker and depending on pacemaker model respond to activity, minute ventilation or a combination of both. The alternative, a fixed rate pacemaker, is programmed at a set rate, and is unable to change with patient activity [18]. Hidaka et al [19], reported their experience with fixed-rate pacemakers in pregnant patients and concluded their safe use, mostly because of the increase in stoke volume that occurs if the pacing rate if set correctly.…”

Section: Pacemaker Technologymentioning

confidence: 99%

Management of Cardiac Pacemakers in a Pregnant Patient

Grover¹,

Sheth²,

Haines³

et al. 2015

OJOG

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Introduction: Despite the increasing use of permanent cardiac pacemakers in a younger patient population, there are little data related to pregnancy. We present our experience in managing a pregnant patient with a pre-existing pacemaker and review the existing literature to establish management guidelines. Case: A 27-year-old G1 P0 presented for prenatal care in the first trimester of pregnancy. She had a past medical history of bradycardia, hypotension and syncope that required dual chamber cardiac pacemaker placement 6 years earlier, and one episode of left upper extremity venous thrombosis related to replacement of the pacemaker wire 4 years earlier. In the early second trimester, the patient began experiencing light-headedness and breathlessness with exertion. The rate settings of the pacemaker were increased with resolution of the patient's symptoms. The patient underwent primary cesarean section at 39 weeks gestation with delivery of a healthy term infant. Preoperative anesthesia consultation was obtained. The postoperative course was uneventful. Pre-pregnancy pacemaker settings were re-established after the postpartum period. Discussion: The current literature on managing pregnant patients with pre-existing pacemakers is quite limited. Such patients require a multidisciplinary approach to care. Normal physiologic changes in pregnancy may necessitate rate adjustments. Other than routine thromboprophylaxis, no other anticoagulation is needed. Route of delivery is generally based on obstetric indications. During surgery consider using bipolar electrocautery in place of unipolar electrocautery, to reduce electromagnetic interference. Also, the placement of the grounding pad should be as far away from the pacemaker as possible. It should be anticipated that the patient will return to her baseline cardiac status postpartum and therefore pacemaker settings can be adjusted accordingly.

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Types of Pacemakers and their Complications

Cited by 38 publications

References 61 publications

Biological Effects and Health Implications of Radiofrequency Radiation

Biological Effects and Health Implications of Radiofrequency Radiation

Delay of Onset of Second Degree Pacemaker Block by Beta‐Blockade in Patients with P‐Synchronous Pacemakers

Management of Cardiac Pacemakers in a Pregnant Patient

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