Pacemaker ECG

1. Pacemaker ECG
Chairperson :
Assoc.Prof.Dr.Md.Abu Salim
Presenter
Dr.Md.Sajjad Safi
MD-Cardiology, Phase-B
Dept.of Cardiology
UCC,BSMMU

2. Aims Pacemaker ECG interpretations
• To ascertain the pacing mode.
• To determine whether the pacing operation is normal or abnormal.
• To define the abnormality if present.
• To differentiate pacing system malfunction from pseudo-malfunction.
• To recognize the presence of an apparent ECG abnormality occurring
due to normal operation of a complex pacemaker algorithm.

3. Types of Pacemakers
• Atrial
• Ventricular
• Dual chamber

5. Pacemaker Electrodes
• There are two types of pacemaker electrodes:
• Bipolar –stimulating electrode (cathode ‘+’ ) at tip
• Unipolar-negative electrode (anode ‘-’) just below the tip(10mm)

6. Pacemaker Identification System

7. Pacemaker artifact

8. Sensing and Pacing Functions
• Fixed rate pacemakers:
• Demand pacemakers:

9. Fixed rate pacemakers

10. Demand pacemakers:

11. Ventricular Pacemakers
• There are three possible single chamber ventricular pacemaker
modes:
• V00
• VVI
• VVT

12. V00 mode:

13. VVI mode:

14. Hysteresis

15. Effect of magnet:

16. Atrial Pacemakers
• A00 mode:
• AAI mode:
• AAT mode:

17. A00 mode:

18. AAI mode:

19. AAT mode:

20. Location of pacemaker electrode

21. Left ventricular pacing

22. Pacemaker Syndrome

23. Dual Chamber Pacemakers
• The different ECG patterns associated with a dual chamber
pacemaker :
■ Atrial pacing in combination with ventricular pacing (AP,VP)
■ Atrial pacing in combination with ventricular sensing (AP,VS)
■ Atrial sensing in combination with ventricular pacing (AS,VP)
■ Atrial sensing in combination with ventricular sensing (AS,VS)

25. DDD Pacing: AP and VP

26. DDD Pacing: AP and VS

27. DDD Pacing: AS and VP

28. DDD Pacing: AS and VS

35. Pacemaker-Mediated Tachycardia

36. ECG Pattern of Other Dual
Chamber Pacemakers
• The ECG of other, less commonly encountered dual chamber
pacemakers are :
• VAT mode:
• DVI Pacing:
• VDD mode:

37. VAT mode

38. DVI mode

39. VDD mode

40. Pacemaker with Antitachycardia
Properties

41. Take home message
• Pacing mode.
• Normal or abnormal pacing.
• Define and find out the cause of abnormal pacing.
• Differentiate between malfunction and pseudo-malfunction.
• Prompt action to be taken before hand.

42. References :
• Basic and bedside electrocardiography: Romulo F.Baltazar
• An introduction to electrocardiography: Leo Schamroth
• Hurst’s the Heart,14th Edition
• Manual of cardiovascular medicine,4th edition: Brain P.Griffin
• Internet browser

43. THANK YOU