Pacemaker failed to sense

Editorial Team / Admin · Jun 15, 2016

Option 1: Try a different pacer. In my experience, there are times the box just doesn't want to cooperate. So, we switch it out. 99% of the time, the issue is resolved.

Option 2: There are multiple different manufacturers of temporary pacemakers. Perhaps you could contact the manufacturer for information on how to troubleshoot the specific device your facility uses.

offlabel · Jun 17, 2016

You didn't say so, but you did rule out AOO, DOO, VOO settings weren't set?

nurs1ng · Jun 17, 2016

You didn't say so, but you did rule out AOO, DOO, VOO settings weren't set?

Yes, mode was set to DDD.

offlabel · Jun 17, 2016

Yes, mode was set to DDD.

OK, so was the pacer capturing or were there just empty pacer spikes? And were the spikes regular?

nurs1ng · Jun 17, 2016

OK, so was the pacer capturing or were there just empty pacer spikes? And were the spikes regular?

Pacer failing to sense completely. It was firing spikes everywhere. Def not failing to capture since pt has been having own sinus beats consistently.

nursej22, MSN, RN · Jun 17, 2016

Perhaps the wires were dislodged. I agree with try a different box, or even switch the wires at the box connection. Perhaps have biomed check that box is working correctly.

offlabel · Jun 17, 2016

I'm not understanding. "capture" means that the heart contracts after each pacer spike. It sounds like the pacer was delivering an impulse asynchronously, which means at a regular intervals. If it were irregular intervals, there might have been intermittent sensing.

It sounds like it was a lead problem... the pacer was firing (you saw the spikes) but was not capturing. It was not sensing because of the asynchrony. So either there was poor lead contact on the heart or the leads were defective for some reason... not unheard of.

Pheebz777, BSN, RN · Jun 18, 2016

I called the cardiologist once for the same problem, but before the MD called back I was messing with the sensitivity and mA but to no avail.

The cardiologist just told me to increase the rate to 80. And it was capturing just great at a rate of 80! Until this day I do not understand how increasing the rate solved the problem

nurs1ng · Jun 22, 2016

I really wish I could've messed with the box more but didn't as this wasn't my patient. Thank god the pacer didn't capture because some of those spikes were all over the place, including landing on T waves. Don't even remember now whether these spikes were firing at regular intervals or intermittently. Should've printed a strip for reference!

I'm not understanding. "capture" means that the heart contracts after each pacer spike. It sounds like the pacer was delivering an impulse asynchronously, which means at a regular intervals. If it were irregular intervals, there might have been intermittent sensing.
It sounds like it was a lead problem... the pacer was firing (you saw the spikes) but was not capturing. It was not sensing because of the asynchrony. So either there was poor lead contact on the heart or the leads were defective for some reason... not unheard of.

OnceMorewithFeeling · Jul 3, 2016

My dearest cardiac nurses,
I have a question that has gotten me stumped. My co-worker received a fresh CABG with epicardial AV wires. The pt brady's down to the 40s (non-sustained) and co-worker decided to place pt on the pacer box with a set rate of 60.
On the monitor, I noticed that pt's pacer spikes were all over the place and not sensing the pt's own intrinsic rhythm. Went to the bedside and told my co-worker about this. I was adjusting the sensitivity setting to no avail - pacer spikes still not sensing pt's own rhythm?! We then decided to just unhook the wires to the box.. thank god the pt was maintaining with a HR of 50-60s with a stable BP.
What else could we have done to have the box better sense the pt's own rhythm? Should I have unhooked the atrial wire from the box and see how the pacer would sense with only the V-wire? And/or vice versa? Thanks for any response!

What was the patient's underlying rhythm (Sinus Brady, Slow A Fib, Junctional Escape)? What were the pacer settings that you tried?

Did you turn the sensitivity numbers down to their minimum and still, the pacer was not sensing the patient's intrinsic rhythm?

1.Changing out the box, suggested above, is always a great idea.

2.You can also try changing out the cords--the ones that go from the epicardial wires to the pacer box.

3. Were the pacer wires appropriately attached to the pacer box? Meaning, were the atrial wires connected to the atrial slot in the pacer and the ventricular wires connected to the ventricular slot?

4. You can also try inserting an indifferent wire.