Cardiac pacemakers: current and future status

Pacemaker diagnostics: a critical appraisal of current technology

Diagnostic information retrieved from a pacemaker offers the ability to improve patient care. Pacemaker diagnostic data provides information regarding pacemaker function and activity, lead function, arrhythmia occurrence, and data to aid in optimal pacemaker programming. Current pacemakers incorporate greater storage capabilities, more efficient means of storing and presenting data between follow-up visits, and more options for programming diagnostic functions and algorithms. The cardiac rhythm of the paced patient can be evaluated via real-time intracardiac electrograms at interrogation, surface electrocardiograms, ambulatory electrocardiograms, and by pacemaker stored diagnostic function that may include stored intracardiac electrograms. This article focuses on the various methods of obtaining diagnostic information regarding pacemaker activity, pacemaker function, and diagnostic information on cardiac arrhythmias. The current clinical applicability and limitations of these methods and the use of stored diagnostic data in the clinical follow-up and study of patients with pacemakers is discussed.

Pacing therapy in the elderly

Bradycardia due to sinus node dysfunction and atrioventricular block is more commonly observed in the elderly. Aging is associated with progressive fibrosis in both the sinus node and atrioventricular conduction system (AV node, His bundle, right and left bundles). In the absence of reversible causes implantation of a permanent pacemaker is often required in the patient with symptomatic bradycardia. For elderly patients with sinus node dysfunction, pacing modes that preserve atrioventricular synchrony are associated with a reduced incidence of atrial fibrillation and improved quality of life. For patients with atrioventricular block, the importance of preserving atrioventricular synchrony in the elderly is controversial and is currently being evaluated.

Unconventional applications in pacemaker therapy

Since its inception, the principal application of permanent pacing has been for the correction of symptomatic bradycardia. During the past 3 decades, pacemaker therapy indications have evolved, through scientific research and through advances in technology, beyond conduction system disorders and sinus node dysfunction. This article presents recent progress in the application of permanent pacing in hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, paroxysmal atrial fibrillation, neurocardiogenic syncope, and in long-QT syndrome. In each clinical entity, certain pacing parameters are crucial for achieving the therapeutic goal. Advanced practice clinicians will encounter these patients in practice and are urged to recognize the therapeutic goal and optimal function of the device.

Transvenous cardiac pacing

Transvenous pacing therapy is a life-saving technique for patients with clinically significant bradyarrhythmias. For most symptomatic bradyarrhythmias in small animals, there is no effective substitute for cardiac pacing. The methods employed for pacemaker placement, although potentially time-consuming, are not technically difficult. This article discusses the indications, techniques, clinical decision-making, and potential complications associated with temporary and permanent transvenous cardiac pacing.

Present status of cardiac pacing: a nursing perspective

In this article, we focus on the nurse's role as caregiver and patient advocate for individuals requiring cardiac pacing. The history of cardiac pacing, new trends, indications for pacing, pacemaker dysfunction and complications, types of pacing, and nursing considerations will be discussed.