Adobe Systems
Bradycardia, pacing
J. Vlašínová
L.Křivan

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Bradycardia
̶ Bradycardia = any heart rate < 50 bpm.
̶ SA node disorder
̶ AV node disorder
leadIIevents

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IKK FN  Brno
Sinus node dysfunction
̶Sinus bradycardia
̶Sinus node arrest
̶SSSy -  tachy – brady form
̶Chronotropic incompetence
̶

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Sinus bradycardia
C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\sinusová bradykardie.jpg

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IKK FN  Brno
Sinus node arrest
Failure of SN discharge – absence of atrial depolarization

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IKK FN  Brno
Sick sinus syndrome (SSS)
Intermitent episodes of slow and fast rhythm from SA node, or atria
vlaš71

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IKK FN  Brno
Chronotropic incompetence
Max
Rest
Heart
Rate
Time
Start
Activity
Stop
Activity
Quick
Unstable
Slow

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IKK FN  Brno
AV node dysfunction
̶AVB I
̶AVB II
̶AVB III
̶

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AVB I.st degree (PQ > 0,2s)
PQ = 0.28s

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AVB II.nd degree (2/1)


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AVB II.nd degree (Mobitz 3/1)
C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\AVB Mobitz 3-1.jpg

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AVB III.rd degree (no secondary, tertiary autom. centre)


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AVB III.rd degree (escape rhythm from AV junction)
C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\AVB III junkce .jpg

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AVB III.rd degree (escape ventricular rhythm)
C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\AVB III.jpg

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IKK FN  Brno
Etiology
̶Age
̶Fibrosis
̶Ischemia (acute, chronic)
̶Inflamation – myocarditis
̶Drugs (antiarrhythmics)
̶Hypothyreosis
̶Hyprekalemia

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IKK FN  Brno
Symptoms
̶Asymptomatic
̶Palpitations
̶Dizziness, weakness
̶Dyspnea
̶Exercise intolerance
̶Syncope
̶Sudden cardiac death

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IKK FN  Brno
Diagnosis
̶ECG
̶Holter (24 hrs – 7 days)
̶Implantable loop recorder
Injectable Reveal In Hand_Telemetry

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IKK FN  Brno
Treatment
̶No treatment
̶Avoiding antiarrhytmic drugs
̶Elimination of reversible cause
̶Atropin, Isoprenalin
̶Temporary external pacing
̶Temporary transvenous pacing
̶Epicardial pacing
̶Permanent transvenous pacing
Indication for pacing – symptomatic bradycardia

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External pacing
http://ems12lead.com/wp-content/uploads/sites/42/2010/12/2010_12_01_TCP_01wm.jpg

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Temporary transvenous pacing
http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79933-80659-1765770.jpg
http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79933-80659-1765771.jpg
http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79933-80659-1765769.jpg
http://europace.oxfordjournals.org/content/europace/8/5/385/F2.large.jpg?width=800&height=600

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Epicardial pacing
HeartVLeadEpiAndEndo01

Permanent pacing from 1958
File:Arne Larsson.jpg
Arne Larsson 1915 - 2001
File:First pacemaker (Siemens-Elema 1958).jpg
Elmquist + Senning 8.10.1958

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Pacing
03_slide 27 03_slide 28
UNIPOLAR
BIPOLAR

Single and dual chambre PM
Description VVI Schrittmacher THWZ.jpg File:Fluoroscopy pacemaker leads right atrium ventricle.png


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IKK FN Brno
Pacing modes
Chamber paced Chamber sensed Function
A (atrium) A (atrium) I (inhibited)
V (ventricle) V (ventricle) I (inhibited)
D (dual A+V) D (dual A+V) D (dual: inh. + triggered)
R (rate responsive)

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Resynchronization therapy (CRT)
Cardiac Resynchronization Therapy (CRT) icd cardiac

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Effect of resynchronization
LBBB prior to CRT implantation
Narrow QRS after CRT implantation

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MRI compatibility
MRI – contraindicated in older types of PM
Surescan_Device MRCONDIT
MRI Safe under specific programming of the device

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IKK FN Brno
Complications of pacing – cardiac perforation
RTG s perforací Snímek 010

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IKK FN Brno
Complications of pacing infection, decubitus
118-1859_IMG

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IKK FN Brno
Complications of pacing pocket hematoma