Monthly Archives: February 2017

What are some common complications after pacemaker implant?


Is subclavian vein insertion the most commonly used technique?

What are some indications to use different veins?


How long does the patient usually stay in the hospital after implantation?


How many CXRs are needed after implantation? One after to check for placement and r/o pneumothorax & comps? One before the pt leaves the hospital?


How often should the pacemaker be checked to make sure it is functioning properly?


How long does the pacemaker battery last?


Will any electrical devices interfere with the pacemaker?

  • Household items, cellular phones should not interfere
  • Antitheft systems & metal detectors can potentially interfere with pacemakers, but this is unlikely
    • May require reprogramming before and after the procedure
  • MRI is a relative contraindication
  • MAGNETS – a magnet placed on the device during the procedure can help make sure there is not any problems with the device


What are some contraindications to pacemaker implantation?


What are some different techniques to keeping pacemaker leads flush to the myocardium?


Questions Dr. Ben-Zur Wants Us to Ask/Have Answered


  • Indications for pacing, defibrillator, BiVD


      • Pacing Indications
        • Bradycardia
        • Tachy-brady syndrome
        • Heart block
        • Neonatal Lupus
      • Defibrillator (ICD) Indications
        • VF/VT
        • Resuscitated sudden cardiac death
        • Congenital long QT syndrome
        • Primary prevention in patients with prior MI (at least 40 days ago) with EF <30
        • Hypertrophic cardiomyopathy
        • Structural Heart disease
        • Brugada
        • NYHA Class II-III + EF <35.
      • BIVD Indications
        • Pacemaker induced Heart failure: caused by longstanding iatrogenic PVC and discoordination between the ventricles.
        • Heart failure.


  • Complications


      • Lead dislodgement/malfunction
      • Infection
      • Pneumothorax
      • Hemothorax
      • Bleeding/hematoma
      • Vessel damage/perforation
      • Venous thrombosis and resultant subclavian vein occlusion
      • Loss of sensing/capture
      • Tricuspid valve injury
      • Bleeding Hematoma
      • Phlebitis or thrombophlebitis of the vein
      • Catheter-related thrombosis (which may lead to pulmonary embolism)
      • Air embolism
      • Dysrhythmias
      • Atrial wall puncture from guide wire (which may lead to pericardial tamponade)
      • Lost guide wire
      • Anaphylaxis
      • Chylothorax (possible with left-side lead insertion)
      • Atrioventricular fistula
      • Twiddler syndrome


  • Various techniques


      • Implantable pacemaker.
        • Insertion sites: subclavian vein, cephalic vein, internal jugular vein, femoral vein.
        • Commonly implanted into the soft tissue beneath the skin in the area below the clavicle (aka prepectoral implantation)
          • Located under the skin and fat tissue but ABOVE the pectoral muscle
          • The leads are attached to myocardial tissue
      • Transvenous Pacing/Endocardial Pacing: Temporary
      • Transcutaneous pacing/External Pacing: Temporary
      • Epicardial pacing: Temporary  


  • Pacemaker Components


      • Pulse Generator
        • Device implanted below the skin
        • This contains the battery and the circuitry
      • Leads
        • Wires inserted through the vein to the heart
        • These connect to the generator and transmit information


  • Different machines available


      • Different pacemakers
        • Single-chamber
          • Consists of one lead (either RA or RV insertion)
        • Dual-chamber
          • Consists of two leads (either RA & RV)
        • Triple-chamber (AKA BIVENTRICULAR PACEMAKERS)
          • Consists of three leads (one in the RA, one to stimulate RV, and one to stimulate LV)
          • Used in pts with weakened heart muscle/heart failure and irregular conduction patterns in the ventricles
          • These “resynchronize” the ventricles and improve the efficiency of heart contraction (aka cardiac resynchronization therapy)
            • Paces both ventricles at the same time → increased CO


  • Leadless systems


    • Small device that is inserted in the RV
    • Components: pulse generator with a battery & a steroid-eluting electrode
    • Indications
      • Bradycardia with single-chamber pacing ONLY
    • Benefits
      • Leads/wires, generator, and surgical pocket are not needed (less invasive than traditional pacemaker implantation)
      • Absence of lump under the skin. The pacemaker can cause positional discomfort in some patients
      • Less time consuming implantation procedure
      • Upper body activity does not need to be limited post-surgery
    • Implantation
      • A catheter is inserted via femoral vein access
      • The catheter will be guided into the RV
      • The pacemaker will be positioned inside the RV and attached to the RV wall
      • The device is tested – check for placement and correct function
      • Catheter is removed
      • Incision site is closed
      • Time: ~ 30 minutes
    • Complications:
      • Bleeding
      • Infection of the incision site
      • Pacemaker dislodgement
      • Internal bleeding (ie pericardial effusion, cardiac tamponade)
    • Examples:
      • St. Jude Medical Nanostim

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