Permanent pacemakers

4 Permanent pacemakers



Background


Cardiac pacing is an established and effective treatment for cardiac arrhythmias and placement of a permanent pacemaker is a common procedure in hospitals. It may be one of your tasks as a junior doctor to arrange check x-rays for such patients and interpret them.


Complications following placement of a permanent pacemaker device are relatively common, 20% in one study [1], and their detection is improved by a knowledge of the commonest things that can go wrong.


Pneumothorax and lead malposition are the commonest complications and they are illustrated below.



Correct placement


The commonest pacing systems are dual-chamber and single-chamber pacing devices.


A good understanding of cardiac anatomy is helpful for interpretation (see Chapter 7).


image

Fig. 4.1 Correctly positioned dual-chamber permanent pacemaker device. The pacemaker box is positioned subcutaneously, usually in the left upper thorax (arrow 1).


In a dual-chamber device there are two pacing leads whose tips should generally be in the right atrium (arrow 2) and right ventricle (arrow 3), respectively.

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Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Permanent pacemakers

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