This document provides an overview of advanced pacing concepts for nurses, including pacemaker modes, troubleshooting complications, thresholds, and nursing management of patients with pacemakers. It defines various pacemaker modes according to the NASPE/BPEG universal code and describes how to recognize and address failures to pace or sense, as well as loss of capture. Threshold testing and sensitivity procedures are outlined. Nursing interventions for pacemaker-related issues are also reviewed.

1. ADVANCED PACING Understanding and Troubleshooting Pacemakers Sherry L. Knowles, RN, CCRN, CRNI

3. Pacemaker

4. Nursing Action

5. Indications for Pacing

8. Pacemaker Types

9. Epicardial Pacing

10. Transcutaneous Pacing

12. Modes of Pacing R D D D Chamber Paced O = None A = Atrium V = Ventricle D = Dual ( A + V) Chamber Sensed O = None A = Atrium V = Ventricle D = Dual ( A + V) Response to Sensing O = None T = Triggered I = Inhibited D = Dual ( T + I) Programmability O = None P = Simple Programmable M= Multiple Programmable R = Rate Modulation

17. Atrial Pacing

18. Ventricular Pacing

21. AV Pacing

24. Rate Response Pacing

27. Failure To Pace

30. Failure To Capture

31. Failure To Capture

37. Failure To Sense

38. Failure To Sense

41. Fusion Beats

43. Pacemaker Magnet Tracing

59. PRACTICE

60. AAI AAI: A pacemaker that stimulates and senses the atrium at one rate

61. VVI VVI: A pacemaker that stimulates and senses the ventricle at one rate

62. DDI DDI: A pacemaker that senses and stimulates both atrium and ventricle. The stimulation rate is fixed.

63. DDD

64. DDD or VVI?

65. DDDR

66. DDI

67. What’s the Mode?

68. What’s the Mode?