Pacemaker Follow Up
by Bert Govig
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1. Does it Pace?
Output measured in Amplitude (Volts)
and duration (Pulse width measured in
Shoot for at least a doubling of
measured threshold. A bit more in
May make exceptions if
Pacemaker has Beat to Beat back
2. Does it sense?
Measured in mV.
Adjusting sensitivity is non-intuitive. Raise sensitivity by
lowering the number and vice versa (think of paradigm of
raising or lowering the fence - pacemaker sees all activity
that is over the fence)
Oversensing can result in non-pacing (really a bad idea in
dependant patients). Undersensing results in inappropriate pacing
and potentially R on T (a bad thing particularly if there is underlying
cardiomyopathy, but probably better than Oversensing in most
3. Are the leads OK?
LBBB pattern in RV pacers.
4. Is the battery OK?
Function (short term / long term)
Strategies to maximize clinical
Strategies to reduce pacing
Rate adjustments, Hysteresis, Night mode
Optimize AV delay
Other strategies to prolong battery life
Accepting smaller safety margins
Turning off monitoring functions
Unipolar pacing is preferred by many
when tolerated as it optimizes
recognition of paced beats on surface
6. Are there arrhythmias?
Burden of A fib
Sudden relative Brady
What you can learn about the
physiology of your patient
"You can see a lot just by
looking" - Y Berra
The value of temporal data
Infection at site of pacemaker. Routine follow up should
always include a look at the pace site (which can break
down years after implant). Patients should be taught to call
if site becomes red.
Pacemaker mediated tachycardia
Short term solutions, Magnet, VVI
Long term solutions, Increase PVARP
5 conditions in which PMT can occur