Pacemakers placement

Hussaine SA, Chalcravarty S, Chaikhouni A. Congenital absence of superior vena cava unusual anomaly of superior systemic veins complicating pacemaker placement. PACE 1981 4 328. 

Raichlen IS, Campbell FW, Edie RN, Josephson ME, Harken AH. The effect of the site of placement of temporary epicardial pacemakers on ventricular function in patients undergoing cardiac surgery. Circulation 1984 70 1118-23. 

An X-ray shows the placement of a pacemaker. Such pacemakers are usually made out of platinum. lAAAGE COPYRIGHT 2009, DARIO SABUAK. USED UNDER LICENSE FROM SHUTTERSTOCK.COM. 

C. Secure venous access. Antecubital or forearm veins are usually easy to cannulate. Alternative sites include femoral, subclavian, internal jugular, or other central veins. Access to central veins is technically more difficult but allows measurement of central venous pressure and placement of a pacemaker or pulmonary artery lines. 

One man receiving intravenous lidocaine had a seizure about two days after starting treatment with amiodarone, and another man with sick sinus syndrome taking amiodarone had a sinoatrial arrest during placement of a pacemaker under local anaesthesia with lidocaine. There is conflicting evidence as to whether or not amiodarone affects the pharmacokinetics of intravenous lido-... 

Harada Y, Katsume A, Kimata M et al (2005) Placement of pacemaker leads via the extrathoracic subclavian vein guided by fluoroscopy and venography in the oblique projection. Heart Vessels 20(1) 19-22... 

A disease model of atrioventricular (AV) block is created in guinea pigs to simulate a common indication for the placement of an electronic pacemaker in... 

The personnel required for insertion of an ICD are very similar to those of the pacemaker implantation. The ICD manufacturer s representative, however, as stated, is controversial. He or she can be an important member of the implantation team and can prove invaluable for providing leads, defibrillators, and support equipment. The earlier ICD implantations that were limited to epicardial placement required a minimum of two trained physicians (an electrophysiologist and a cardiac surgeon). With the transition to the nonthoracotomy approach, a well-trained electrophysiologist working with an ICD manufacturer s representative is frequently all that is required. The ideal constitution of an ICD implantation team is listed in Table 4.1. Each member of the ICD implant team should be completely familiar with the unique requirements of an ICD implantation. This includes a protocol for patient rescue, should it be required. The circulating nurse is responsible for running... 

Fig. 4.29 Use of the right iliac vein for placement of pacemaker leads. The leads are nltimately tunneled using a Penrose drain to a pocket created in the right upper quadrant. (From EUestad MH, French J. Iliac vein approach to permanent pacemaker implantation. Pacing Clin Electrophysiol 1989 12(7Pt 1) 1030-1033, with permission.)...

Fig. 4.41 Location of surgical incisions for placement of epicardial systems. The common median sternotomy is not shown. (From Belott PH, Reynolds DW. Permanent pacemaker implantation. In Ellenbogen KA, Kay N, Wilkoff BL, eds. Clinical cardiac pacing. Philadelphia WB Saunders, 1995, with permission.)...

The pectoral pocket, once exclusively used for permanent pacemakers, is now employed for nonthoracotomy ICD placement. This is because of the... 

Fig. 4.64 Lateral view demonstrating transhepatic lead placement. (Fishberger SB, Camunas J, Rodriguez-Femandez H, et al. Permanent pacemaker lead implantation via the transhepatic route. Pacing Chn Electrophysiol 1996 19(7) 1124-1125, with permission.)...

Fig. 4.69 Atrial lead placement. Insert in the upper right shows atrial endocardial lead being placed through the wall of the right atrial appendage with the tip of the pacemaker lead abutting the endocardial surface. A pursestring suture is placed around the lead at the point of entry. The relationship of the atrial lead is also shown. (Hayes DL, Vhetstra RE, Puga FJ, et al. A novel approach to atrial endocardial pacing. Pacing Clin Electrophysiol 1989 12(1 Pt 1) 125-130, with permission.)...

LV pacing has undergone considerable evolution in its short history. Initially, pacemaker electrodes were placed in the coronary sinus using a stylet-driven technique. This has evolved to the currently acceptable use of a guiding catheter contrast venography for either a stylet-driven or some form of guidewire-assisted placement. 

After venous access, some consideration should be given to the sequence of lead placement. Some operators prefer to place the RV electrode first for emergency RV pacing, should heart block ensue because the heart failure patients commonly have a left bundle branch block and any trauma to the conduction system or right bundle may result in complete heart block. Other operators choose to place the coronary sinus lead first and, if necessary, depend on heart rate support via a temporary transvenous pacemaker placed via the femoral vein. The issue of failure speaks for placing the coronary sinus lead first. Should the procedure fail with unsuccessful left-sided left ventricular lead placement and the patient has already received right-sided electrodes, a pacing system may be left without an indication unless a future second attempt is considered. As more and more systems are placed for a primary prevention indication like MADIT II, this has become less problematic (153). 

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