Pacemaker codes help....

  1. So my pt is on the telemetry floor and he has a medtronic pacemaker in place. I am researching on pacemakers to fully understand all the nursing implications involved but I am having trouble understanding the Pacemaker codes.

    I found a nice chart on medscape and have been reading by medsurg book(I use Brunner and Suddarth) but I just don't get it!!!

    1st Position 2nd Position 3rd Position 4th Position 5th Position




    Response to


    Rate Modulation Multisite Pacing
    A A T O O
    V V I R A
    D D D V
    O O D
    Abbreviations: A, atrium; V, ventricle; D, dual (both chambers); O, none; T, triggered; I, inhibited; R, rate adaptive.
    ^^^that's what I found...

    My pt's chart says "AAI>DDD 60-100bpm", "AP:97%" and "VP23.9%"

    Pleeease help me understand what these codes mean. I have two pages of notes but I just can't get my head wrapped around this. Sigh. Thanks <3
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    About on eagles wings

    Joined: May '09; Posts: 1,074; Likes: 706
    nurse; from US
    Specialty: 2 year(s) of experience in sdu, tele


  3. by   nurseprnRN
    to understand pacers, you have to think like one. fortunately for us, pacers have really limited cognitive and executive skills. pretty much all they can do is look to see if an impulse comes their way from normal heart activity or not, and then they either shoot out a pacing impulse or they don't. some are smart enough to count to ten before they do that, just in case an impulse is slow in coming. that's largely it.

    aai means the pacer senses and senses in the atria, and will be inhibited (sit and watch) if it sees anything in the atrium (it won't pace if it sees a beat). if it doesn't see anything happen, to, it will pace.

    ddd means it looks at atria and ventricles, and will pace, sense, or sit and watch, depending on what's needed. it might help you to think of there being two little pacers in that chest, one watching and pacing the atria, and one watching and pacing the ventricles.
    the atrial pacer tells the ventricular pacer what it's doing, too, so the ventricular pacer knows what's going on in the atria. the ventricular pacer part of the pacemaker is told how long to wait before pacing the ventricle, on the off chance that the patient's own conduction system will pass the atrial beat along through the av node successfully. this is sorta how it is told to think:

    1) watch atria for specified time, see no beat>pace atria. then:
    1a) watch ventricle for specified time, see a beat>do nothing
    1b.) watch ventricle, see nothing in specified time>pace ventricle
    or this could occur:
    2. watch atria for specified time, see beat>do nothing. then:
    2a) watch ventricle for specified time, see a beat>do nothing
    2b.) watch ventricle, see nothing in specified time>pace ventricle

    lather, rinse, repeat for every beat.

    if you hear the term "hysteresis," it doesn't mean what the cardiologist feels when the wires break. :d it means that the pacer knows it's supposed to pace at a given rate, but it won't kick in at that rate until the patient's own rate is some less. for example, if it's set at 80, it will spit out impulses (or run through that cycle above) to give the patient a minumum of 80 beats per minute. but it won't start doing this until it sees the patient's own rate drops down to (whatever...let's say 65), and them it kicks in at 80. this lets people have lower rates for sleep, for example, but never lets them get too low.

    ( but this is a great site to help you understand.
  4. by   netglow
    Other than knowing what's in there and understanding why the patient has one... This will give you your pathophysiology and I am guessing you need to do your careplan and what not. The pacer is there, you find out why, then you assess the patient with a cardiac focus (hint). Device patients often know all about this stuff. You might fish around and see if they don't teach you!!! Any chest pain, palpitations, SOB, cough, presyncope (when), syncope.

    Lots to learn about electrophysiology, but you need pretty specific literature - not in your nursing text.

    Oh I forgot, was eating Easter jellybeans and dropped the last grape one!!!!!! OMG (the horror). Anyhoo, you can look up testing on the patient if any. Echo, Stress test, etc. Read the associated reports. See if there is any notation of any procedures that are dysrhythmia related... eg. Afib (ablation), etc.
    Last edit by netglow on Feb 23, '12
  5. by   on eagles wings
    Guys, thanks sooo much! Always brilliant replies!! This is all very new to me and I will be sharing all this info with my classmates. Very important for us to know in tele!
  6. by   Pneumothorax
    lol funny u ask about this, i had a patient with a DDD in and had NO idea what it meant. And the best part was we just had a test on pacemakers, cardiac, stemi etc.. pacemaker notes was like 2 slides of the ppt.

    nice that they left the important stuff off LOL!

    thanks for the chart OP!