Indications For Bradycardia Pacing 10.1.14

Front 1

Two big categories of indications for a pacemaker

Back 1

Problems with impulse formation or impulse conduction

Front 2

SA Node & AV Node

Back 2

Slower phase 0 and leaky (upslope) phase 4

Front 3

Internodal Tracts from far right atrium to left atrium

Back 3

Posterior internodal tract, internodal tract, anterior internodal tract, Bachman's Bundle

Front 4

Internodal Tracts vs. Cell to Cell depolarization in Atria

Back 4

Tracts depolarize faster than myocardium on their own

Front 5

AV Node Benefits

Back 5

Augment ventricular filling, protective, can act as backup pacemaker

Front 6

Left Bundle Branch Subdivides

Back 6

Posterior Fascicle of LBB (under), Anteror Fascicle of LBB (over)

Front 7

Depolarization

Back 7

occurs cell to cell

Front 8

Repolarization

Back 8

Occurs in many cells over the same time

Front 9

BPM to ms

Back 9

60,000/bpm

Front 10

ms to BPM

Back 10

60,000/ms

Front 11

Normal PR interval

Back 11

120-200 ms

Front 12

QRS Interval

Back 12

60-120 ms

Front 13

QT Interval

Back 13

360-440 ms

Front 14

Symptoms Associated with Bradycardia

Back 14

Syncope or pre-syncope, dizziness, shortness of breath, exercise intolerance, Mental Confusion, Palpitations, Congestive heart failure

Front 15

Stokes Adams Syndrome

Back 15

Syncope with bradycardia from CHB

Front 16

Dspynea

Back 16

Shortness of breath

Front 17

Documentation Symptoms while having Bradycardia

Back 17

EKG, Holter, Event Monitor, Exercise Test, Tilt Table, Implantable loop recorder, iRhythm Zio Patch

Front 18

Holter Monitor

Back 18

24 hour review of symptoms

Front 19

Event Monitor

Back 19

3 to 4 week review for symptoms

Front 20

Implantable loop recorders

Back 20

2 to 3 years review for symptoms

Front 21

iRhythm Zio Patch

Back 21

14 day review for symptoms

Front 22

Sinus Bradycardia

Back 22

Rates less than 60 bpm, needs symptoms to qualify for PPM

Front 23

Sinus Arrest

Back 23

Failure of sinus node discharge resulting in the absense of atrial depolarization and periods of ventricular asystole (3.5 seconds), needs symptoms to qualify for PPM

Front 24

SA Block

Back 24

SA node fires and stays in rhythm. The conduction does not make it through the perinodal tissue (surrounding the SA Node) to depolarize the atria. Most commonly a double interval (1.4 second pause), needs symptoms to qualify for PPM

Front 25

Brady-tachy Syndrome

Back 25

Intermittent episodes of slow and fast rates from SA node or Atria, often fast is from episodes of PAF, needs symptons to qualify for PPM

Front 26

Chronotropic Incompetence

Back 26

Heart rate does not meet metabolic demand. Could be part of the time or all the time, needs symptoms to qualify for PPM

Front 27

Pacemaker Indication Class I

Back 27

Conditions for which there is evidence and general agreement that PPM should be implanted

Front 28

Pacemaker Indication Class II a

Back 28

conditions for which there is divergence of opinion with respect to the necessity of PPM insertion. Weight of evidence/opinion is in favor of usefulness/efficacy

Front 29

Pacemaker Indication Class II b

Back 29

Conditions for which there is divergence of opinion with respect to the necessity o PPM insertion. Usefulness/efficacy is less well established by evidence/opinion

Front 30

Pacemaker Indication Class III

Back 30

Conditions for which there is general agreement that PPM is unnecessary

Front 31

Pacemaker Indication Level A

Back 31

data derived from multiple randomized clinical trials involving a large number of individuals (more common in ICDs)

Front 32

Pacemaker Indication Level B

Back 32

Data derived from a limited number of trials involving comparatively small numbers of patients or from well-designed data analysis of nonrandomized stuies

Front 33

Pacemaker Indication Level C

Back 33

Consensus of expert opinion was the primary source of recommendation (more common in PPMs)

Front 34

First-degree AV Block

Back 34

Prolonged PR interval (>200ms). Rare indication for pacing, even with symptoms. Proven that patients with 1 degree AV block have higher chance of producing AF. Usually SupraHis.

Front 35

Second-degree AV Block Mobitz Type I

Back 35

Progressive prolongation of the PR interval until a QRS beat is dropped. Group beating. With symptoms, is anindication for pacing. Usually Suprahis.

Front 36

Second-degree AV Mobitz Type II

Back 36

some P-waves do not conduct to ventricle. With or without symptoms, is an indication for pacing. Usually InfraHis

Front 37

Third-degree AV Block

Back 37

No impulse conduction from atria to ventricles. With or without symptoms, is an indication for pacing. Usually InfraHis

Front 38

SupraHis

Back 38

Block between the A and H waves

Front 39

InfraHis

Back 39

Block between the H and v waves

Front 40

Children more likely to have what kind of QRS in Complete Heart Block

Back 40

Junctional (more normal looking) QRS

Front 41

Surgery most likely to result in pacemaker implantation

Back 41

Aortic Valve Replacement

Front 42

Bifascicular Block

Back 42

Right bundle branch block and lef posterior OR anterior hemiblock. Complete Left Bundle branch block. Prolonged QRA (>120ms). Symptomatic is prone to sudden cardiac death

Front 43

Trifascicular Block

Back 43

Complete block in the right bundle branch and complete or incomplete block in both divisions of the left bundle branch. Must be intermittent in one fascicle. Symptomatic is prone to sudden cardiac death.

Front 44

Hypersensitive Carotid Sinus Syndrome (CSS)

Back 44

dilated portion of the carotid artery that has pressure-sensitive receptors that regular HR & BP. Results in Bradycardia. Can be induced by Tight colllar, shaving, head turning, exercise. Right carotid more sensitive than left

Front 45

Vasovagal Syndrome (VVS)

Back 45

Neurally mediated transient lossof consciousness. Syncope triggered by fear, anxiety, physical pain, prolonged standing Most common cause of Syncope (common in children)

Front 46

Pacing after cardiac Transplantation

Back 46

8-23% get PPMs. Indications are sinus bradycardia and/or chronotropic incompetence

Front 47

SA Node

Back 47

Heterogenous tissue with multiple cell types. Approximately 1% of the cells act as the leading pacemaker site. Generates phase 4 depolarization by activation a hyperpolarization-activated inward current I9f) [funny current}

Front 48

How long SND is believed to evolve over

Back 48

10 to 15 years

Front 49

SA Node cells function at 75

Back 49

10% of cells

Front 50

Risk of developing AV block following PPM

Back 50

3 to 35% within 5 years.

Front 51

Physiologic

Back 51

Maintaining AV synchrony

Front 52

Pacing in V in patients that don't need it

Back 52

Hurts Patients

Front 53

Incorrect Rate Adaptive Pacing

Back 53

Causes more A-pacing. Can increase AF possibility

Front 54

Familial SND

Back 54

mutations in the Na+ genes

Front 55

Aging

Back 55

decrease in the overall heart rate, loss of SA cells, ad increase in conduction time Common)

Front 56

Ischemia

Back 56

CAD responsible for about 1/3 of SND (Common)

Front 57

AF

Back 57

commonly leads to SND, 1st demonstrated in chronic tachy-pacing in dogs

Front 58

Diabetes

Back 58

miscrovasculopathy and increased SND

Front 59

Extreme Physical Training

Back 59

Decrease in intrinsic pacemaker activity persists

Front 60

Leading Causes of Chronic SSS

Back 60

aging process, ischemia, amyloidosis, inflammatory conditions, cardiomyopathy

Front 61

SSS Survival Rates to General Population

Back 61

Surive about the amount of time

Front 62

AAI Pacing

Back 62

Safe and reliable mode of pacing for SND, even in the very long-term