What Is Involved in a Pacemaker Placement?

In 1952, PaulZoll first performed temporary cardiac pacing with a pulsed current through two needles connected to a buried needle in the chest wall through two electrodes in a ventricular arrest patient, although this technique was not comfortable for the patient, and it was It lasted only 25 minutes in one patient and only 5 days in another patient, but this report suggests the possibility of providing temporary ventricular rate support to patients with clinically significant bradycardia. Since then, the technology has been further developed, and endocardial, transpericardial, and transesophageal temporary pacing have been successfully developed. All methods are based on an external pulse to provide heart rate support through the electrodes. When many patients requiring temporary pacing are transient or have a correctable cause, it can be easily removed after a short period of pacing. In some patients, a permanent pacemaker needs to be installed before the temporary pacemaker is removed.

Cardiac pacing

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In 1952, PaulZoll first performed temporary cardiac pacing with a pulsed current through two needles connected to a buried needle in the chest wall through two electrodes in a ventricular arrest patient, although this technique was not comfortable for the patient, and it was One

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Complications related to temporary pacing can be related to a variety of factors, including venipuncture injury, mechanical stimulation of the heart lead, electrical activity of the pacemaker lead,

An external pacemaker can regulate pacing output (voltage and / or current, newer products may have pulse width), pacing frequency, pacing mode, and sensitivity. Dual-chamber pacemakers will provide greater flexibility in pacing mode and provide adjustment of atrioventricular delay. The pacemaker can be small enough that the patient can move around or place it next to the bed as needed. The pacemaker battery must be checked daily and the pacemaker placed safely to prevent it from falling down and lead unplugging.

Some pacemakers provide high-frequency pacing (usually three times the upper limit of normal pacing) to provide overspeed pacing suppression for tachycardia. Activation of this mechanism is usually locked and unlocked when needed.

Newer digital temporary pacemakers are often locked after inspection and adjustment to prevent unintentional changes to the procedure.

Functional role of pacing mode

Most temporary transvenous pacing includes stimulation of the right ventricular apex. This involves a detrimental effect on cardiac function and loss of atrioventricular synchronization. Compared with sinus rhythm of the same heart rate, cardiac output is reduced. Murphy (6) et al. Reported in 1992 that temporary ventricular pacing was not better than bradycardia with autonomous rhythms at 80 beats / min (10 cases had heart block, 2 cases had junctional bradycardia), and physiological double cavity (DDD) Pacing can increase cardiac output, increase blood pressure, and reduce pulmonary arterial pressure and right atrial pressure. It is suggested that most temporary pacing should be atrioventricular synchronization in the presence of normal sinoatrial function. Despite this, the complex process of temporary transvenous double-lumen pacing has led clinicians to long-term, routine use of ventricular pacing during temporary pacing. In emergency or acute situations, the use of high pacing frequencies is particularly compensatory. Patients with persistent hypotension after any temporary ventricular pacing should consider restoring and maintaining atrioventricular synchronization. Atrioventricular synchronization is especially valuable for maintaining ideal cardiac function and reducing AF after cardiac surgery; care should be taken to observe the electrical activity of the atrial pericardial lead, as sensory features often decline after 4 to 5 days.