Pacemaker register electrical events and respond if necessary to the delivery of electrical stimulation to the heart. The electrodes of permanent pacemakers are either placed at a thoracotomy or transvenously placed. The electrodes temporary pacemaker in the emergency treatment can also be placed on the chest walls.

The need to treat an arrhythmia depends on the symptoms and the risks inherent in this arrhythmia in itself. The therapy is based on the reasons behind any particular arrhythmia. If necessary, a direct antiarrhythmic therapy with anti-arrhythmic drugs, cardioversion, defibrillation, implantable cardioverter-defibrillators (ICDs), pacemaker (and a special form of “pacing”, cardiac resynchronization therapy), or a combination of these forms of treatment may be necessary. Pacemaker register electrical events and respond if necessary to the delivery of electrical stimulation to the heart. The electrodes of permanent pacemakers are either placed at a thoracotomy or transvenously placed. The electrodes temporary pacemaker in the emergency treatment can also be placed on the chest walls. As a transvenous pacemaker inserted © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video. var model = {videoId: ‘4536776205001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘’, title: ‘Like a transvenous pacemaker is inserted’ description: ” credits’ © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Implanted pacemakers var model = {thumbnailUrl: ‘/-/media/manual/professional/images/pacemaker_placement_high_blausen_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/pacemaker_placement_high_blausen_de.jpg ? lang = en & thn = 0 ‘, title:’ Implanted pacemaker ‘, description:’ ‘credits”, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); Indications for a pacemaker Many arrhythmic there is the indication for pacemaker implantation (see table: Indications for permanent pacemaker). These include generally symptomatic bradycardia or atrioventricular (AV) block of higher degree. Some tachyarrhythmias can be terminated by the so-called. Overdrive pacing. Here, the ventricle is stimulated with short sequences that are above the natural frequency of the patient. After overdrive pacing, the pacing rate is reduced to the desired frequency. However, devices with additional possibility for cardioversion and defibrillation are more suitable for the treatment of ventricular tachyarrhythmias (implantable cardioverter defibrillator). Clinical calculator: QT interval correction (ECG) indications for permanent pacemaker arrhythmia Indicated (established by instructions) if necessary indexed and supported by many references if necessary indexed, but less well supported by evidence not indicated sinus node dysfunction Symptomatic bradycardia, including symptomatic frequent sinus pauses and bradycardia due to essential drugs (alternatives contraindicated) symptomatic chronotropic incompetence (heart rate can not physiological requirements are met) heart rate of <40 beats / min, when the symptoms were not clearly associated with bradycardia syncope of unknown origin with significant ECG on the apparent or triggered in an electrophysiological study sinus node dysfunction heart rate <40 beats / min in minimally symptomatic patients while awake Asymptomatic bradycardia symptoms that match bradycardia, one of which was clearly shown, however, that they are not in touch with her Symptomatic bradycardia due to essential medicines AV block Each AV block 3rd or 2nd degree, which with symptomatic bradycardia or ventricular arrhythmia associated AV block 3rd or 2nd degree advanced on each anatomical plane, when it is one of the following conditions in connection: must be administered cardiac arrhythmias and other disorders for which bradycardia causing drugs documented asystole ? 3.0 seconds (? 5.0 s in atrial fibrillation) that focus, a spare rhythm of <40 beats / min or escape rhythm under the AV node in asymptomatic patients Ventricular escape rhythms of> 40 beats / min in patients with LV dysfunction cardiomegaly or catheter ablation of the AV node is not expected that a post-operative block after engagement triggers neuromuscular diseases with AV block (eg. As myotonic muscular dystrophy, Kearns-Sayre syndrome, limb-, Charcot-Marie-Tooth disease [peroneal muscular atrophy]) load () ie during which occur in patients without myocardial ischemia Asymptomatic AV-block of 3rd degree on each anatomical level if the average ventricular frequency in patients without cardiomegaly on waking ? 40 beats / min Asymptomatic AV block 2nd degree type II with a narrow QRS complex Asymptomatic AV block (is the insertion of a cardiac pacemaker with wide QRS index indexed) 2nd degree within or below the His bundle, discovered during a survey conducted electrophysiological study atrioventricular block grade 1 or 2 with symptoms suggestive of a heart pacemaker syndrome heart block in patients who are taking a causal drug or who have a drug toxicity when conveniences expected rted is that the block relapsed, even after the drug was discontinued AV block of any degree (including 1), associated with neuromuscular diseases in which can progress conduction disturbances unpredictable (z. B. myotonic muscular dystrophy, limb-, Charcot-Marie-Tooth disease [peroneal atrophy] associated with or without symptoms) Asymptomatic AV block 1st degree AV block Asymptomatic 2nd degree type I not known at the AV node, or if the or under the bundle of His AV block that is likely to dissolve or does not return (for. example, due to drug toxicity or Lyme disease, or asymptomatic occurring during a temporary increase in the vagal tone or during hypoxia in sleep apnea syndrome) tachyarrhythmias Persistent, break-dependent with or without prolonged QT interval high-risk patients with congenital long QT syndrome Symptomatic, recurrent SVT, reproducible terminate VT by pacing therapy when ablation and / Or drugs are not effective (except when there is an accessory AV connection which is capable of high-frequency antegrade line) prevention of symptomatic, recurrent atrial fibrillation, unresponsive to medication if simultaneously a sinus node dysfunction is present Frequent or complex ventricular ectopia without sustained VT when no long QT syndrome exists torsades de pointes with reversible causes prevention of atrial fibrillation in patients without an additional indication for pacing after acute myocardial infarction sustained AV block 2nd degree in the His-Purkinje system with bilateral branch block or AV block 3rd degree within or below the His-Purkinje system Temporary AV block 2nd or 3rd degree u nder the AV node associated with bundle branch block Sustained symptomatic AV block 2nd or 3rd degree AV block lasting No 2nd or 3rd degree AV nodal Transient AV block without intraventricular conduction disorders Transient AV block with insulated left- anterior fascicular Acquired branch block or fascicular without AV block Sustained AV block 1st degree with bundle branch block or fascicular Multifaszikulärer block Intermediate AV block 2nd degree or intermittent AV block 3rd degree AV-block type II 2nd degree Alternating branch block syncope, which can not be shown that they (for other possible causes due to an AV block va VT) occur exclude Stark prolonged HV interval (?100 ms) in asymptomatic patients, accidentally during an electrophysiological study covers non-physiological, infra-His block induced by pacing therapy accidentally during an electrophysiological study covers neuromuscular diseases in which can progress conduction disorders unpredictable (z. B. myotonic muscular dystrophy, limb-, Charcot-Marie-Tooth disease [peroneal atrophy] with or without symptoms) fascicular without AV block or symptoms fascicular with AV block first degree and without symptoms Congenital heart disorders Intermediate AV block 2nd or 3rd degree of symptomatic bradycardia, ventricular dysfunction or low cardiac output result has sinus node dysfunction, which is correlated with symptoms during a non-age-appropriate bradycardia Postoperative, high-grade AV block 2nd or 3rd degree, in which a resolution is not expected or ? 7 days after surgery holding Congenital heart block 3 . degree with a wide QRS escape rhythm, complex ventricular ectopy or ventricular dysfunction congenital heart block 3rd degree in infants with a ventricular rate of <55 beats / min or with congenital heart disease and a ventricular rate of <70 beats / min Persistent break dependent VT, with or without a prolonged QT interval, when the effectiveness of the pacing therapy has been demonstrated Congenital heart disease and sinus bradycardia, to prevent recurrent episodes of intra-atrial reentry Congenital heart block 3rd degree holding after 1 year of life when the average heart rate is <50 beats / min, the ventricular rate abruptly 2 or 3 times as long as the basic cycle length paused, or associated symptoms due to chronotropic incompetence occur Asymptomatic bradycardia in children with complex congenital heart disease and a resting heart rate of <40 beats / min or pauses> 3 s in the ventricular rate patients with congenital heart disease and impaired hemodynamics due to sinus bradycardia or loss of AV synchrony Unexplained syncope in patients in whom a congenital heart disease was treated surgically and by transient AV block of 3rd degree with residualem fascicular complications resulted Transient postoperative AV-block of 3rd degree, who converted to sinus rhythm with residualem bifaszikulären block Congenital AV-block of 3rd degree in asymptomatisc hen infants, children, adolescents or young adults with an acceptable ventricular rate, a narrow QRS complex, and normal ventricular function Asymptomatic sinus bradycardia after biventricular repair of congenital heart defects in patients with a resting heart rate of <40 beats / min or breaks the ventricular rate of> 3 s. Temporary postoperative AV block when the AV conduction in the normal state returns Asymptomatic postoperative bifaszikulärer block with or without AV block 1st degree and without previous transient AV block 3rd degree Asymptomatic AV block type I 2nd degree Asymptomatic bradycardia, when the longest RR interval <3 s continues, and the minimum heart rate> is 40 beats / min hypersensitive carotid and neurokardiogenene syncope Recurrent syncope by spontaneously occurring Karotissinusstimulation or Karotissinusdruck, the asystole of> 3 s induced recurrent syncope without any apparent triggering events and a hpyersensitiven kardioinhibitorischen reaction (ie induced asystole Karotissinusdruck of> 3 sec) Significantly symptomatic neurokardiogenene syncope with clinically documented or during tilt table testing occurring bradycardia Hyperactive cardioinhibitory response to Karotissinusstimulation no symptoms or vague symptoms (eg. As dizziness, drowsiness) Situational vasovagal syncope, which can be prevented by avoiding After heart transplant Persistent inappropriate or symptomatic bradycardia, which is expected to last Other established indications for permanent pacing therapy No Longer lasting or recurring relative bradycardia, the rehabilitation or dismissal of postoperative Recreation restricts syncope after the transplant, even if bradyarrhythmia was not detected No Hypertrophic cardiomyopathy same as the established indications for Sinusknotendysf unction or heart block No to medical treatment is not appealing, symptomatic hypertrophic cardiomyopathy at rest or significant obstruction induced left ventricular outflow tract Asymptomatic or medically controlled hypertrophic cardiomyopathy Symptomatic hypertrophic cardiomyopathy with no evidence of obstruction of the left ventricular outflow tract Cardiac resynchronization therapy (CRT) in patients with severe systolic heart failure CRT (with or without ICD) for patients with LVEF ? 35%, LBBB, QRS duration ? 0.15 s, sinus rhythm, and symptoms of heart failure NYHA class II, class III or class IV outpatient with optimal medical treatment CRT (with or without implantable cardioverter defibrillator [ICD]) in patients with left ventricular ejection fraction (LVEF) ? 35%, sinus rhythm, LBBB, QRS duration 0.12 to 0.149 s ,, and symptoms of heart failure NYHA class II, class III or class IV outpatient with optimal medical treatment for CRT patients with left ventricular ejection fraction (LVEF) ? 35%, sinus rhythm, non-LBBB, QRS duration ? 0.15 s and symptoms of heart failure NYHA class III or class outpatient IV with optimal medical treatment CRT for patients with LVEF ? 35% for AF, which otherwise meet the criteria for the CRT, and AV nodal ablation or a pharmacological therapy which will allow almost 100% of ventricular pacing CRT for patients with LVEF ? 35%, the new or replacement equipment with expected> 40% ventricular pacing obtain LVEF ? 30% caused by ischemic heart disease) in sinus rhythm, the QRS duration ? 0.15 s and symptoms of heart failure NYHA class III with optimal medical treatment LVEF ? 35%, sinus rhythm, non-LSB, QRS duration ? 0.12 to 0.149 s, sinus rhythm and symptoms of heart failure according to NYHA class III or ambulatory class IV with optimal medical treatment LVEF ? 35%, sinus rhythm, not LBBB, QRS duration ? 0.15 s and II symptoms of heart failure at optimal medical therapy NYHA class I or II symptoms and non-LBBB QRS pattern with QRS duration <0.15 s comorbidity and / or frailty, limited survival with good functional status to <1 AF = atrial fibrillation; AV = atrioventricular; BBB = bundle branch block; EF = ejection fraction; HV interval = beginning of interval from the HIS signal to the beginning of the first ventricular signal; ICD = implantable cardioverter defibrillator, LBBB = left bundle branch block; LV = left ventricular; NYHA = New York Heart Association; SVT = supraventricular tachycardia; VT = ventricular tachycardia. Data from Epstein AE, DiMarco JP, elbow KA, et al: 2012 ACCF / AHA / HRS focused update incorporated into the ACCF / AHA / HRS 2008Guidelines for device-based therapy of cardiac rhythm abnormalities. Circulation 117 (21): e350-E408, 2008 Circulation127 (3): E283-E352, 2013. types of pacemakers The different types of pacemakers are characterized by 3 to 5 points (see Table: Pacemaker codes). The letters indicate which chambers are stimulated, which chambers are recognized in what way the pacemaker is realized on the arrhythmia responses (inhibitory or stimulatory) whether the heart rate is increased during exercise (frequency adapted pacemaker) and if multiple ventricles are stimulated ( both atria, the two chambers or more than one pacing electrode in a heart chamber). A VVIR pacemaker z. B. stimulates the chamber (V), events takes in the chamber true (V) is inhibited in response to the sensed event stimulation (I) and can increase the rate during physical activity (R). VVI - and DDD pacemaker are the devices most commonly used types. They both offer equal chances of survival. However, physiological pacing (AAI, DDD, VDD) appear to reduce and slightly better contribute to a higher quality of life compared to VVI pacemakers rather the risk of atrial fibrillation (AF) and heart failure. On progress in the development of cardiac pacemakers include lower power consumption, battery types and corticosteroidbeschichtete electrodes (reduce the pacing threshold); all contribute to a longer working life of the pacemaker. The mode change refers to the automatic change in pacing mode in sensed events (eg. B. at VHF switching from DDDR to VVIR mode). Pacemaker codes 1 II III IV V stimulation of registration response to registered signal frequency adaptation multifocal stimulation Atrium A = A = 0 = 0 = No atrium Nonprogrammable 0 = No V = ventricle V = ventricle I = Inhibited Pacemaker A = atrium D = dual (two) D = dual (two) T = Triggers pacemaker to stimulate the ventricles R = adaptively V = ventricle D = dual (both): inhibitory to in Venrikeln the registered signals; activating registered in the atrium signals D = Dual (both) complications in the use of pacemakers pacemaker dysfunction are a faulty perception of events (over - or undersensing) error in the pacemaker or capture function or stimulation with a different frequency. Tachycardias are a particularly common complication. Adapted frequency pacemakers can the stimuli in response to a shock, muscle work or stress induced by magnetic fields increase during an MRI scan. In a pacemaker-induced tachycardia a normally functioning dual chamber pacemaker records a premature ventricular contraction or a paced ventricular beat, which has been transmitted through the AV node or a retrograde accessory pathway to the atrium and then triggers a ventricular pacing in a rapid, repetitive sequence. In addition, arise in a normally functioning device complications. By the so-called crosstalk inhibition, in which the perception of an atrial stimulation pulse by the ventricular channel of a dual-chamber pacemaker leads to inhibition of the ventricular stimulation; may cause (z. B. dyspnea) by the pacemaker syndrome in which an induced ventricular AV asynchrony temporary indefinite cerebral symptoms (eg. B. drowsiness), cervical symptoms (eg. B. pulsations in the neck) or respiratory ailments. The pacemaker syndrome is caused by the restoration of AV synchrony by atrial pacing (AAI), single-lead atrial sensing and ventricular pacing (VDD) or dual-chamber pacing (DDD), but most often treated by the latter. The pacemaker function by electromagnetic sources are disturbed (as diathermy during surgery and MRI scans). The MRI can be performed possibly when the pacemaker unit and the electrodes are not in the magnetic field. Mobile phones and electronic safety devices are potential sources of interference for pacemakers. Phones should not be worn close to the pacemaker. However, the normal use of mobile phones is not a problem. Metal detectors can be passed safely as long as the pacemakers staying in the detector zone any longer.

Health Life Media Team

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