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Pacing

The majority of patients admitted to the CVICU have temporary or permanent pacemaker systems. Pacing is frequently misunderstood. The videos and examples on this page are designed to help all staff attain proficiency in the management of these devices.

What is the problem with the following ECG taken from a patient that has just been admitted from the operating room following cardiac surgery?

Yes, that’s right it is asynchronous mode dual chamber pacing and runs the risk of a pacing spike on the T wave inducing ventricular fibrillation.

For this reason all patients need to have their pacemaker checked once per shift.  Click on the following video (Pacemaker Check 1)to see how to perform a simple pacemaker check of a VVI system:

 

Pacemaker Check 2

Once you have mastered performing a pacemaker check for a simple VVI system, move on to performing a pacemaker check on a dual chamber system (see below).

 

Pacemaker Check 3

Once you have mastered this have a look at the following video showing one of the possible pit falls that you may encounter when conducting a pacemaker check.

 

Pacemaker Check 4

In the next tutorial a pacemaker check is performed on a patient with a prolonged PR interval (and bifascicular block). He needs to be protected from high grade A-V blockby his pacemaker but has a sinus rate of 92 bpm when the pacemaker check is performed. This patient demonstrates the difference between having atrial tracking is enabled in DDD mode and disabled in DDI mode.