Contemporary pacemakers: what the primary care physician needs to know. Clinical procedures in emergency medicine. Pacemaker troubleshooting: common clinical scenarios. Pacing features that mimic malfunction: a review of current programmable and automated device functions that cause confusion in the clinical setting. The rhythm originates in the sinus node, with ventricular. Braunwald’s heart disease: a textbook of cardiovascular medicine. Unit 5B-Pacemaker malfunctions-Fail to pace-capture-sense Nursing B49: Unit 5 Failure to Pace. Philadelphia: Mosby 2009.īonow RO, Mann DL, Zipes DP, Libby P, editors. Marx JA, Hockberger RS, Walls RM, Adams J, editors. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. ![]() The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. : Accessed 01 April 2011.īernstein A, Daubert J, Fletcher R, Hayes D, Lüderitz B, Reynolds D, et al. ![]() In: Gale encyclopedia of surgery: a guide for patients and caregivers 2004. Multiple causes including oversensing, wire fracture, lead displacement, or interference.įailure to capture occurs when paced stimulus does not result in myocardial depolarisation.Ford-Martin PA, Spiwak AJ. Results in decreased or absent pacemaker function. Output failure occurs when a paced stimulus is not generated in a situation where expected. Reduced pacemaker output / output failure may be seen on ECG monitoring if the patient stimulates their rectus or pectoral muscles (due to oversensing of muscle activity). These inappropriate signals may be large P or T waves, skeletal muscle activity or lead contact problems.Ībnormal signals may not be evident on ECG. Oversensing occurs when electrical signal are inappropriately recognised as native cardiac activity and pacing is inhibited. Multiple causes including electrode displacement, wire fracture, electrolyte disturbance, MI or exit block. Undersensing occurs when the pacemaker fails to sense native cardiac activity.Ĭauses include increased stimulation threshold at electrode site (exit block), poor lead contact, new bundle branch block or programming problems.ĮCG findings may be minimal, although presence of pacing spikes within QRS complexes is suggestive of undersensing. Failure to capture occurs when paced stimulus does not result in myocardial depolarisation. Failure to capture occurs when a pacing stimulus is generated, but fails to trigger myocardial depolarization. Pacemaker malfunction can occur for a wide variety of reasons, ranging from equipment failure to changes in underlying native rhythm.ĭiagnosis of pacemaker malfunction is challenging and often associated with non-specific clinical symptoms while ECG changes can be subtle or absent. Underlying rhythm left on its own, with a long pause followed by a ventricular escape beat. The ekg strip below shows the first two spikes pacing, then the pacemaker fails to pace. ![]() Its absence will result in the underlying rhythm running (if any). It may be the pacemaker battery, the leads or it could be an over sensing problem. In general, you will have no pacing spikes where they need to be. It could be an intermittent problem or failure altogether. There is no particular rhythm to define this. Somehow, the electrodes have no current flowing through them. Spikes are sensing correctly and pace the ventricles.įailure to output (failure to pace) simply means there is no output signal being generated from the pacemaker. (undersensing) shows the first two spikes fire out of place. Sensing issues are identified when there are pacemaker spikes showing up where they do not belong. Which occurs when a foreign signal (non-cardiac) such as a muscle twitch, are mistaken for real cardiac activity. On the ECG, failure to capture is identified by the presence of pacing spikes without associated myocardial depolarization. Sensing problems include “undersensing” where the pacemaker fails to sense the native cardiac rhythm. Failure to capture occurs when a pacing stimulus is generated, but fails to trigger myocardial depolarization. In most cases, sensing problems are less threatening and can be corrected by performing a pacemaker interrogation. The example below shows the first two ventricular paced beats capture, then the next This is identified by having pacing spikes present with no resulting QRS, (capture). Failure to capture is when the pacemaker signal fires but there is no response.
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