![]() ![]() D: The pacemaker is capable of sensing intrinsic cardiac activity in both the atria and ventricles.D: The pacemaker is capable of pacing both the atria and ventricles.Revised NASPE/BPEG Generic (NGB) Pacemaker Code A timer can reset which starts the timing cycle over again from the beginning.A timer can complete its cycle and release a pacing stimulus (or initiate another timing cycle).Pacemakers function based on timing cycles. Prevention and termination of arrhythmias.Does the device need to be interrogated?.Is the rate appropriate for the clinical condition?.Could there be intermittent loss of capture?.Is there a paced rhythm on the monitor?.Could the pacemaker be part of the problem?.What is the reason the patient is undergoing medical evaluation?.The clinician should ask the following questions: However, this information is often not available at the time of medical evaluation (although you can ask to see the patient’s device I.D. The diagnosis that necessitated a pacemaker.Become familiar with the “four faces” of DDD pacingĪ basic knowledge of how pacemakers function can be useful when interpreting paced rhythms.Understand the basics of single chamber and dual chamber pacing modes.Develop awareness of the revised NASPE/BPEG Generic (NGB) Pacemaker Code.Review the indications for permanent pacing.With false capture, you will generally see a near-vertical upstroke or down-stroke to the “phantom” QRS complex (which is actually electrical artifact created by the current passing between the pacing pads). You can see another example where an echo was used to verify capture here. The patient’s blood pressure subsequently increased to 90 mmHg.” ![]() The current was gradually increased to 110 mA, and the heart began to contract in unison with the pacer shocks. These heart contractions did not correspond with the surrounding thoracic muscle contractions generated by the pacer. “Initially, the ultrasound demonstrated ventricular contractions at a rate of 30-40 beats per minute. With the etiology of the patient’s hypotension unclear, the decision was made to use transthoracic ultrasonography to assess the adequacy of her ventricular contractions.” The patient appeared to have palpable pulses however, the rhythm contractions of the patient’s body from the pacer shocks made this assessment difficult. The EKG monitor continued to demonstrate adequate ventricular capture by the pacer. “Shortly after cardiac pacing was initiated, the patient’s systolic blood pressure dropped to 50 mmHg. Consider this excerpt from the Journal of Emergency Medicine where Douglas Ettin, M.D. There are many reasons why medical professionals often fail to achieve true electrical and mechanical capture. The problem of false capture (also known as echo distortion) is under-recognized and under-reported in the medical literature. Transcutaneous pacing (TCP) is a difficult skill that is often performed incorrectly. The patient eventually expires from multiple-system organ failure. In the ICU the patient remains dangerously hypotensive in spite of dobutamine and levophed drips.She is sent to the cardiac cath lab where a permanent pacemaker is placed.On arrival at the hospital the patient is transitioned to transvenous pacing.However, she is still non-verbal and does not follow commands. The patient begins to move and reaches for the pacing pads. 9% normal saline is run wide open with an additional IV line established in the left lower extremity.0.5 mg of Atropine is administered x 3.IO access is obtained in right proximal tibia.However, paramedics are still concerned about the patient’s hypotension. ![]() The patient’s blood pressure improves slightly to 84/47 (confirmed by auscultation). Pacing spikes are visible with what appear to be large, corresponding QRS complexes. The transcutaneous pacer is set for 70 PPM at 50 mA. ![]()
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