Permanent Pacemaker (PPM, ICD, CRT)

What is a pacemaker?

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles). A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure and hypertrophic cardiomyopathy.

PACING MODE

Pacing mode is declared by an abrreviation consisting of 3 to 5 letters. These letters describe, in chronological order, the following:

1. The chamber paced: O (omitted), A (atrium), V (ventricle), or D (dual, atria and ventricles)

2. The chamber sensed: O (omitted), A (atrium), V (ventricle), or D (dual, atria and ventricles)

3. Response to sensed events: O (omitted), I (inhibited), T (triggered) or D (dual, inhibited and triggered)

4. Rate responsiveness: O (omitted, none) or R (rate responsive)

5. Multisite pacing (pacing in multiple places in the same chamber: O (omitted), A (atrium), V (ventricle), or D (dual, atria and ventricles)

If the pacemaker is not rate responsive, then the fourth letter may be omitted. This also applies to the fifth letter (multisite pacing).

Example: DDDR pacemaker:

D = Dual pacing (pacing in the atria and ventricles)

D = Dual sensing (sensing in the atria and ventricles)

D = Dual response (can be both inhibited and triggered)

R = Rate responsive (the pacing rate can be adapt to physical activity)

In clinical practice, DDD, VVI, and AAI are the most common, with or without rate responsiveness.

Done under Mild-Moderate Sedation

Basic Kits:

1 Barts Device Pack

2 Chloraprep (10mL)

1 Ioban

1 Medium Image Intensifier cover

1 Diathermy pen

1 scratch pad

1 500mL NaCL bag (sterile)

Sutures: (operator preference)

1 Ethibond (for securing leads)

1 Vicryl tie (for cephalic approach)

1 PDS 2-0 or 3-0, or monocryl 3-0, or vicryl 2-0 (for deep tissue curve suture)

1 Monocryl curve 4-0 or 3-0, or Monocryl straight 3-0 (for skin suturing)

1 Steristrip

1 Softpore dressing

Note: If Lead Revision/Box Change use plasma blade instead of diathermy + scratch pad (plasma blade doesn’t need scratch pad)

If CRT/HIS Pacing: (Basic kits + additional equipment)

1 Shoulder Rad Pad

1 20ml Luer lock

1 Small trolley cover

1 Terumo 150cm or 180cm

1 Angioplasty wire (ChoICE PT ES or floppy)

1 Bowl with pure contrast (small bowl) - for small injection to locate branches

If Device Extraction (Basic kits + addtional equipment)

1 Shoulder Rad Pad

1 Small trolley cover

1 Terumo 150cm or 180cm

1 Big swabs (warings)

extra non-absorbable sutures (usually ethibond/silk)

For S-ICD Implant (Basic kits + addtional equipment)

Note: usually done under General Anaesthetic but if MD wants to do it under nerve block, they will need:

1 Peripheral Ultrasound

1 Probe cover

2 Chloraprep (Large)

1 Nerve block needle with 2 ports

Chirocaine (Levobupivacaine), Marcaine, Lidocaine

*need special arm board to abduct the left arm, INCOPAD - to secure arm on the arm board

*special drape - 5pcs drape (arm, 2 sides, 1 leg, 1 head)

*additional sutures:

2 Ethibonds

2 PDS 2-0 or 3-0, or monocryl 3-0, or vicryl 2-0 (for deep tissue curve suture)

2 Softpore dressings

Special Thanks to Kimberlie Mae Garcia

Vein Access: