Monitoring a Patient with a Simple Pacemaker or Defibrillator


• highly specialized monitoring: ECG standard is necessary but not enough; mandatory biannual visit to the “rhythm specialist-Stimuliste”.

• The pacemaker dysfunction is mentioned so inadequate spikes or spikes depolarization not followed, or if recurrence of discomfort or loss of consciousness.

• The ventricular repolarization is uninterpretable, whether on the stimulated QRS QRS or spontaneous.

• shock felt by the patient carrying a defibrillator: rhythmological opinion urgent!

• Carrying a card bearing the characteristics of the pacemaker. MRI examinations prohibited.

Monitoring a Patient with a Simple Pacemaker or DefibrillatorThe different types of pacemakers:

The most common types of stimulation:

. Stimulator “simple”

VVI: pacing and ventricular sensing

AAI pacing and atrial detection.

DDD pacing and sensing of both chambers, the more physiological.

VVIR, AAIR, DDDR: frequency locked to the activity between two determined values.

The indications of stimulation type depend on the specialist (age, sinus function, atrial activity, conductive disorder …).

The lifespan of the battery is between 5 and 8 years (depending on usage).

. Stimulator called “multisite” (3 cardiac leads) for severe heart failure requiring “resynchronisation” of the ventricles.

. ventricular defibrillator for patients exposed to the rhythmic sudden death.

Clinical monitoring:

Malaise, syncope?

unusual dyspnea? Pain? Shock felt?

Palpitations abnormal?

or diaphragmatic stimulation chest?

Appearance of the scar: normal, inflammatory?

Electrical monitoring:

Plot full rest and during maneuvers deep breath type thwarted supply of arms, mobilization cabinet …

Stimulus default spike not followed by depolarization (atrial or ventricular as appropriate).

Fault detection of spontaneous activity: inadequate spike.

The heart rate may be lower than that given on the book if there is a hysteresis (in fact, to prevent the pacemaker to activate when the spontaneous FC nearly the stimulation frequency, we can add an extra timeout called “hysteresis”).

Most models have a Holter function “embedded” (checked during inspections by the rhythm specialist) who faithfully remembers the rhythmic events passed between two controls. A conventional ECG Holter recording can be performed to more accurately.

The pacemaker carrier card:

She mentioned the implant center, the implanter physician, date of installation, the make and type of the battery (housing) and / sensor (s), date and parameters set at the last control, signs of wear …

Practical advice:

– Authorized: wearing a seat belt. Wearing a pacemaker should be declared to his auto insurer.

– Prohibited:

– Setting of an electric motor,

– Prolonged sun exposure on the housing,

– Sports with risk of injury,

– Proximity to electromagnetic fields,

– Wearing a digital walkman or a GSM phone or wireless side of the case,

– Extended stay between terminals burglar shops,

– MRIs.

– Electrosurgical unit, surgery: ask opinion to the rhythm specialist.

– Removal of the housing before incineration.