HIND COLLEGE OF NURSING

Safedabad, barabanki

SUBJECT-ADVANCE NURSING PRACTICE

ASSIGNMENTS
ON
Topic- PACEMAKER

SUBMITTED TO SUBMITTED BY
MRS. ABHILASHA SAHA MS. SAROJ TIGGA
ASSOCIATE PROFESSOR M.Sc. NURSING 1ST YEAR
HOD CHILD HEALTH NURSING HIND COLLEGE OF NURSING

Pacemaker
Introduction

 The true beginning of the concept of a pacemaker began over 200 years ago.
In the late 1700s, Luigi Galvani discovered that he could cause contraction
of a frog heart simply by passing an electrical current through the heart. This
concept was further realized nearly 100 years later with the first successful
resuscitation of a child by Guilliame de Boulogne utilizing electricity. He
was able to accomplish this by introducing an electrical current to the
patient's chest with a return electrode on the leg after a drowning. After this
feat, much successful resuscitation was reported, leading to the term
"artificial cardiac pacemaker" by Dr. Hyman in 1932.
 Pacemakers are adjustable artificial electrical pulse generators, frequently
emitting a pulse with a duration between 0.5 and 25 milliseconds with an
output of 0.1 to 15 volts, at a frequency up to 300 times per minute. The
cardiologist or pacemaker technologist will be able to interrogate and control
the pacing rate, the pulse width, and the voltage, whether the device is
temporary or permanent. Pacemakers are typically categorized as external or
internal. The external variety is almost always placed for temporary
stabilization of the patient or to facilitate some type of surgical procedure.
The implantable type is usually permanent and often, significantly more
complex than the temporary, external variety.
 Pacemakers are the electrode device that can be used to initiate the heartbeat
when the hearts intrinsic electrical system cannot effectively generate a rate
adequate to support cardiac output.
 A pacemaker is an electronic device that provides electrical stimuli to the
heart muscle.
Definition

 A pacemaker is an electronic device used to pace the heart when the normal
conduction pathway is damaged or diseased.

Components of pacemaker

 Electronic Pulse generator; contain the circuitry and batteries that determine
the rate (beat per minute) and the strength or output (millamperes) of the
electrical stimulus delivered to the heart.
 Pacemaker electrodes (leads); which carry the impulse created by the
generator to the heart.
1. Endocardial leads.
2. Epicardial wires.
 Most pacemaker have elective replacement indicates when the battery is
approaching depletion. The pacemaker contin

Etiology

 The American College of Cardiology (ACC), the American Heart

Association (AHA), and the Heart Rhythm Society (HRS) has jointly
established national guidelines to direct the implantation of artificial cardiac
pacemakers. A detailed discussion of these guidelines is beyond the scope
of this article, but an outline will be presented. The main indications for
pacemaker implantation include:

 Symptomatic bradycardia from sinus node disease

 Symptomatic bradycardia from atrioventricular node disease

 Long QT syndrome
  Hypertrophic obstructive cardiomyopathy

 Dilated cardiomyopathy

 During AV node ablation

 Cardiac resynchronization therapy with biventricular pacing

 Advanced 2nd or third-degree heart block

 Recurrent syncope

There are different types of pacemakers.

Temporary pacemaker:

 Are intended for short-term use during hospitalization. Are used to support
patents until they improve or reserve permanent pacemakers.
 Epicardial wires and the endocardial may be temporary.
 Located outside the body, and may be taped to the skin or attached to a belt
or to the patient’s bed.
 The temporary generator size is about the size of a small paperback book.

Permanent pacemakers

 Permanent pacemakers are pacemakers that are intended for long-term use.
 Endocardial leads.
 The generator implanted in a subcutaneous pocket.
 They last approximately 6 to 12 years.
  The permanents generator it weight less than 1oz and is the size of a thick
credit card.
 Single chamber pacemaker. This type usually sends electrical signals to
the lower right chamber of the heart.

 Dual chamber pacemaker. This type sends electrical signals to the upper
and lower right heart chambers.

 Biventricular pacemaker. This type also is called a cardiac

resynchronization pacemaker. It's for people who have heart failure and a
slow heartbeat. The device stimulates both lower heart chambers. It helps
make the heart muscle stronger.

 Indication of temporary pacing

 Maintenance of adequate heart rate and rhythm during special circumstances
such as surgery and postoperative recovery, cardiac catheterization or
coronary angioplasty.
 Before implantatation of a permanent pacemaker.
 As prophylaxis after open heart surgery.
 Acute inferior MI with symptomatic bradycardia and AV block.

Nursing management

 1. Monitoring the patient’s cardiac rhythm and pacemaker

function. Regular evaluation of the patient’s cardiac rhythm and pacemaker
function is important to ensure optimal heart function and the effectiveness
of pacemaker therapy.
 2. Proper wound care. Maintaining a clean and sterile wound environment
promotes healing, reduces the risk of wound-related complications, and
 ensures the pacemaker continues to function optimally without interruption
or the need for further interventions.
 3. Observing for pacemaker-related complications. Pacemaker-related
complications can include infection at the insertion site, lead dislodgement
or fracture, hematoma formation, pneumothorax, thrombosis or embolism,
malfunction or electrical issues, and allergic reactions or interference with
other devices.
 4. Providing emotional support. This involves actively listening to the
patient’s concerns and fears, validating emotions, and offering reassurance
and empathy.
 Patient education and teaching. Providing education and support to the
patient and the family about the pacemaker function, activity restrictions,
and signs of complications.

 Perform a focused history and physical to determine the presence of a CIED

utilizing a review of medical records, chest x-rays, electrocardiograms, and
palpation of the device.

 Determine the type of CIED and its function by inspecting device card,
utilizing chest x-ray, and interviewing the patient. It is critical to determine
if the device is a pacemaker or ICD.

 Determine if the patient is dependent on the device's pacing function.

 Determine if electromagnetic interference will occur during the surgical

procedure and if so, suspend the anti-tachyarrhythmia functions by
reprogramming or use of a magnet if applicable; consider placing external
defibrillator pads if the device has been deactivated and placed pads as far
from an implantable device as possible.
 Monitor function of the device intraoperatively; special conditions include
lithotripsy, MRI, electroconvulsive therapy, and radiation therapy.

 Postoperatively, monitor rhythm and device function, obtain interrogation of

the device, and restore settings as appropriate.

 Differential Diagnosis

 Acute coronary syndromes

 Cardiogenic pulmonary edema

 Carotid sinus hypersensitivity

 Hyperparathyroidism and thyrotoxicosis

 Hypothyroidism

 Pacemaker malfunction

 Pacemaker mediated tachycardia

 Paroxysmal supraventricular tachycardia

 Pulmonary embolism

Complication

 Complications occur during pacemaker insertion and include:

 Pneumothorax

 Wound infection

 Pericarditis

 Skin erosion
  Lead dislodgment

 Hematoma

 Failure to sense, capture or output

 Pacemaker mediated tachycardia

 Twiddler syndrome

 Pacemaker syndrome

 Pacemaker pseudomalfunction

References
 Chung MK, Daubert JP. Pacemakers and implantable cardioverter-
defibrillators. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL,
Solomon SD, eds. Braunwald's Heart Disease: A Textbook of
Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022: chap
69.
 Crofoot M, Sarwar A, Weir AJ. StatPearls [Internet]. StatPearls Publishing;
Treasure Island (FL): Sep 12, 2022. External Pacemaker. [PubMed]
 Ivanchina AE, Kopylov FY, Volkova AL, Samojlenko IV, Syrkin AL.
[Clinical Value of Algorithms of Minimization of Right Ventricular Pacing
in Patients With Sick Sinus Syndrome and History of Atrial
Fibrillation]. Kardiologiia. 2018 Aug;(8):58-63. [PubMed]
 Baltazar, Romulo F. (2012-03-28). Basic and Bedside Electrocardiography.
Lippincott Williams & Wilkins. 978-1-4511-4791-9.
 Sharma, Parikshit S.; Vijayaraman, Pugazhendhi; Ellenbogen, Kenneth A.
(2020). "Permanent His bundle pacing: shaping the future of physiological
ventricular pacing". Nature Reviews Cardiology. 17 (1): 22–36.