PPM Question

[Wheaties1974]

Recently I was recovering a patient from open heart surgery and the patient had av pacing wires connected to a dual chamber packing box. The surgeon wanted the patient a paced at a rate of 80 with v pacing backup at 50. We could not figure out how to do this. Ultimately, we increased the av interval on the pacer which prevented v pacing unless a qrs was not sensed within 270ms. Does anyone have an opinion on this? Was there another option? The MD had not idea how to program the box for what he wanted. thank you

[Biffbradford]

I guess the first question is: What temporary pacer do you use? You should have a manual somewhere. Clinical engineer? I know in the temp. pacers I've always used, this wouldn't be possible. There is one rate setting, that's it.

[ICURN3020]

All I could think of when reading this is I hope I never end up in the hospital needing some device for my heart that neither the staff nor the physician knows how to use properly!

[MunoRN, RN]

I've never seen an external pacemaker that could be set up to do that, and for good reason. I suppose you could sort of rig up something using two different pacemakers in the case of complete heart block, which could pace the atria and ventricles asynchronously, but I really don't recommend it.

Even though they are sensing and pacing two chambers, pacemakers have only one rate setting, for good reason. The purpose of A-pacing is to utilize the AV node to "pace" the ventricles, which preserves the atrial kick and the more efficient motion of an intrinsic ventricular contraction. All you can change is the AV-delay, which can be adjusted to make it more likely the ventricles will contract as the result of intrinsic conduction through the AV node, rather than being paced.

[Esme12, ASN, BSN, RN]

I have A paced an open heart on the epicardial leads You set the A pace to asynchronous and v pace demand. What did cardiology say.

[Biffbradford]

Also, why is this "PPM"?

[canned_bread]

I don't know what type of machine you are using, so can't advise you. However, I hope you realise how important it is to know how to use one of these. If the pacer stops working (or you program it wrong) you can potentially have a patient in asystole. It's so, so critical. As critical as CPR. So I suggest you get some instruction ASAP.

[kool-aide, RN]

Also, why is this "PPM"?

Permanent pacemaker

[JeffTheRN]

Technically speaking, epicardial leads to an external pacemaker is not a PPM. But that's really just splitting hairs.