Pacing systems implanted devices

An integral part of many pacing system follow-up programs is transtelephonic monitoring (TTM) (72-74). This can be initiated by the physician and support staff out of an individual office or provided by a commercial service based on a specific prescription by the physician. Reports of each periodic evaluation are sent to the patient s physician. TTM provides a cost-effective means for frequent monitoring as the implanted device is getting older and there is concern about approaching RRT. It also provides a link between the patient and the physician for those patients who hve alone, who are very anxious, or pacemaker dependent. 

As an aide to the evaluation so that nothing is overlooked, we have developed a worksheet that is then used to generate the final summary note. This is shown in Fig. 19.24. The front side of the sheet has clinical data based on history and the examination while the reverse side has the detailed measurements from the pacing system including capture and sensing thresholds. As noted at the bottom (Fig. 19.24), special information that may impact the follow-up schedule such as unstable threshold, pacemaker dependency, on advisory, and for devices that have been implanted for many years, a indication of their age can be identified. 

The book is divided into four sections. The first section describes pacing leads and pacemaker function. The second section focuses on device implantation. New to this edition is a chapter on implantation of left ventricular leads, used in the biventricular pacing systems intended to treat patients with heart failure. Purposely we have asked two experienced implanters to discuss then-personal methods for placing leads in the cardiac venous systems to illustrate the diversity of techniques and tricks of the trade. The third section reviews the use of implantable cardiac devices in particular clinical situations. All of the chapters from the first edition have been extensively revised new to this edition are chapters on device use for patients with atrial fibrillation, heart failure, and syncope, providing further evidence for the expanding indications... 

Braun MU, Rauwolf T, Bock M, Kappert U, Boscheri A, Schnabel A, Strasser RH. Percutaneous lead implantation connected to an external device in stimulation dependent patients with systemic infection - A prospective and controlled study. Pacing Clin Electrophysiol 2006 29 875-879. 

Implantation of transvenous ICD systems employs techniques similar to those used for permanent pacemaker implantations, and is discussed in detail in a separate chapter in this book. Connecting ICD leads to the device is slightly different than connecting pacemaker leads to pacemaker generators. All ICD pulse generators have at least three ports for single chamber devices (four ports for dual chamber devices, and five ports for CRT-D). One LV port is for the pace/sense IS-1 terminal pin, and two are for the defibrillation coil (usually DF+ and DF-). The second DF port may be capped if a single coil... 

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