placing atrial epicardial wire into ventricular port of pacer

Specialties MICU

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Does anyone have experience with placing an atrial pacing wire into the ventricular port of a pacer in order to increase the available output? Is there anything special we need to know about the rest of the settings after doing this? i.e. the pacer is now sensing the atrial activity I believe, but it "thinks" it's ventricular, is there a possibilty of inappropriate firing???

Specializes in CCU/CVU/ICU.

As to Atrial pacing A-fib, I've done it,

,

NOPE. you have not. You may think you have but....

I would challenge any nurse reading this to ask a cardiologist, EP_doc, or cv-surgeon if you can pace(atrial-pace...not ventricular pace a-fib) a fibrillating atrium. Please! PLEASE!

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Specializes in CCU/CVU/ICU.
If the doc wanted you to do this, he needs to be getting a cardiologist in to place a permanent pacer, PERIOD, plain and simple. If you need that much output, that pacing wire ain't gonna last long anyhow. Now in lieu of placing a permanent pacer, I HAVE SEEN atrial pacing done via a Transvenous pacer, but only on a couple of rare occasions. As far as "Can you do it?" Yes, but you can only pace in AAI mode or Asynchronous atrial pacing, and you have to keep in mind that the pacer WILL NOT have the capabilities of pacing the ventrical if it is arranged this way!!!!

The bolded parts are partially incorrect,

As to the original question,

Now...explain to me HOW this is partially incorrect?? Do you understand the term, 'potentially'??? And atrial pacing a-fib...??

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Specializes in CCU/CVU/ICU.

your idea of 'asynchronously pacing' a fibrillating atria.. Yes, you can set the pacer this way, and will see pacemaker spikes. BUT THATS NOT pACING because you're not capturing the atria.

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Specializes in Cardiac, Post Anesthesia, ICU, ER.

your idea of 'asynchronously pacing' a fibrillating atria.. Yes, you can set the pacer this way, and will see pacemaker spikes. BUT THATS NOT pACING because you're not capturing the atria. .

.... every once in a while, I see something that may not be 100% right, and try to provide more info. I actually enjoy most of your posts as you seem to have an excellent variety in your knowledge base, probably beyond 99% of the other posters here. (You can take that as you wish, but it IS intended to be a compliment, not a sarcastic dual meaning statement.)

I can show you strips from epicardial pacers that weren't hooked up right, and show you that the patient, VERY FORTUNATELY, had no "lethal" arrhythmias, as you stated. I've seen it at least a dozen times, when nurses who didn't have any business setting pacers up set them up without asking for assistance. Likewise, I've paced over A-Fib at least a dozen times, and all except a patient who'd lost his RCA graft, and lost his RV( CVP was 25, with a BP of 60/30-ish), had at least 10-15 mm of Hg increase in their SBP. And as stated below, the best case scenario gained 25-30 mm of Hg. Interestingly enough, he was an electrician, so when I explained to him electrically what I was doing, he almost understood.

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Specializes in CCU/CVU/ICU.
.... every once in a while, I see something that may not be 100% right, and try to provide more info. I actually enjoy most of your posts as you seem to have an excellent variety in your knowledge base, probably beyond 99% of the other posters here. (You can take that as you wish, but it IS intended to be a compliment, not a sarcastic dual meaning statement.)

Alright. When you argue so violently with someone you're not supposed to compliment people...it's kinda like a low-blow. I suppose the best way for me to reply is by apologizing. I get so worked up that i get headaches...(i'm not kidding).

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Specializes in Critical Care.

Not to contribute to the last exchange, but it seemed to me that the original question had to do with generating some temporary kick or overdrive capacity in the few hours immediately post-op and not related to electrical problems that would require a permanent solution or pacer.

More of a benefit and not an emergency. That was my read on it.

I think the biggest issue was addressed: make sure you don't have both the atrial and ventricular wires crossthreaded to eliminate the risk of reverse (or as someone said, retrograde) pacing.

~faith,

Timothy.

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Specializes in Cardiac, Post Anesthesia, ICU, ER.
Not to contribute to the last exchange, but it seemed to me that the original question had to do with generating some temporary kick or overdrive capacity in the few hours immediately post-op and not related to electrical problems that would require a permanent solution or pacer.

More of a benefit and not an emergency. That was my read on it.

I think the biggest issue was addressed: make sure you don't have both the atrial and ventricular wires crossthreaded to eliminate the risk of reverse (or as someone said, retrograde) pacing.

~faith,

Timothy.

Actually Timothy, those wires should pick up fine at 2-4 milliAmps, and if they are needing to switch to the ventricular side to get more output (up to 25mA), the patient's wires are likely not functioning well, if at all, and the patient is in need of another form of pacing. And as stated above, the risk of retrograde pacing isn't nearly as concerning as most people believe. I've seen it many times, and never seen it cause any lethal arrhythmias any of those times.

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