1,943
edits
Case reports from Michael Rosengarten: Difference between revisions
Jump to navigation
Jump to search
Case reports from Michael Rosengarten (view source)
Revision as of 07:02, 15 February 2012
, 15 February 2012→Cardiac Pacemakers
| Line 168: | Line 168: | ||
==Cardiac Pacemakers== | ==Cardiac Pacemakers== | ||
A review of cardiac pacing | *[[McGill Case 98|A review of cardiac pacing]] | ||
Modes of cardiac pacing | *[[McGill Case 42|Modes of cardiac pacing]] | ||
Definitions of different pacing modes | *[[McGill Case 42|Definitions of different pacing modes]] | ||
===Examples of different pacing modes=== | ===Examples of different pacing modes=== | ||
====DDD pacemakers==== | ====DDD pacemakers==== | ||
DDD timing diagram in sinus rhythm with an AV delay of 80ms. | *[[McGill Case 42|DDD timing diagram in sinus rhythm with an AV delay of 80ms.]] | ||
DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing. | *[[McGill Case 42|DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing.]] | ||
DDD mode showing ventricular tracking of atrial fibrillation | *[[McGill Case 42|DDD mode showing ventricular tracking of atrial fibrillation | ||
DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms. | *[[McGill Case 42|DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms.]] | ||
DDI pacing at a lower rate of 50/min | *[[McGill Case 42|DDI pacing at a lower rate of 50/min ]] | ||
DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality | *[[McGill Case 42|DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality]] | ||
DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter | *[[McGill Case 42|DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter]] | ||
DDD pacemaker failing to sense a P wave | *[[McGill Case 42|DDD pacemaker failing to sense a P wave]] | ||
DDD pacemaker the effect of a PVC on the timing cycles | *[[McGill Case 42|DDD pacemaker the effect of a PVC on the timing cycles ]] | ||
DDD pacemaker timing diagram with atrial lead pacing the ventricle | *[[McGill Case 42|DDD pacemaker timing diagram with atrial lead pacing the ventricle]] | ||
A patient with atrial tachycardia with an intra-atrial recording from his pacemaker | *[[McGill Case 42|A patient with atrial tachycardia with an intra-atrial recording from his pacemaker ]] | ||
Ladder diagrams and tracings while in DDI mode and complete heart block. | *[[McGill Case 42|Ladder diagrams and tracings while in DDI mode and complete heart block.]] | ||
DDD pacer set at 70/min. but atrial pacing at 75/min due to conduction with a PR interval shorter than the A/V interval set on the pacemaker. | *[[McGill Case 42|DDD pacer set at 70/min. but atrial pacing at 75/min due to conduction with a PR interval shorter than the A/V interval set on the pacemaker.]] | ||
Recording from the atrial lead of a patient with atrial fibrillation | *[[McGill Case 42|Recording from the atrial lead of a patient with atrial fibrillation]] | ||
====Atrial pacing==== | ====Atrial pacing==== | ||
AAI with ladder diagram | *[[McGill Case 42|AAI with ladder diagram]] | ||
AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia. | *[[McGill Case 42|AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia.]] | ||
A series of electrocardiograms from a 78 year old woman who was implanted with a VVI pacemaker in 1991. The patient developed congestive heart failure five years later due to pacemaker syndrome which was corrected by switching to atrial pacing. | *[[McGill Case 42|A series of electrocardiograms from a 78 year old woman who was implanted with a VVI pacemaker in 1991. The patient developed congestive heart failure five years]] | ||
A patient with an atrial pacer that did not seem to pace properly. | *[[McGill Case 42|later due to pacemaker syndrome which was corrected by switching to atrial pacing.]] | ||
Two rhythm strips from a patient with an AAI.R pacemaker with atrial sensing of the QRS due to a prolonged PR interval. | *[[McGill Case 42|A patient with an atrial pacer that did not seem to pace properly.]] | ||
12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm | *[[McGill Case 42|Two rhythm strips from a patient with an AAI.R pacemaker with atrial sensing of the QRS due to a prolonged PR interval.]] | ||
A rhythm strip from a patient that shows AAI pacing competing with and resetting the patient's nodal rhythm. | *[[McGill Case 42|12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm]] | ||
Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes | *[[McGill Case 42|A rhythm strip from a patient that shows AAI pacing competing with and resetting the patient's nodal rhythm.]] | ||
An irregular rhythm with an atrial pacemaker. | *[[McGill Case 42|Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes]] | ||
*[[McGill Case 42|An irregular rhythm with an atrial pacemaker.]] | |||
====Ventricular Pacing==== | ====Ventricular Pacing==== | ||
VVI with ladder diagram | *[[McGill Case 42|VVI with ladder diagram]] | ||
Ventricular paced rhythm with atrial flutter | *[[McGill Case 42|Ventricular paced rhythm with atrial flutter]] | ||
VVI pacing in patient with first degree A/V block | *[[McGill Case 42|VVI pacing in patient with first degree A/V block]] | ||
Ventricular paced rhythm with atrial flutter after A/V nodal ablation. | *[[McGill Case 42|Ventricular paced rhythm with atrial flutter after A/V nodal ablation.]] | ||
The effect of an acute myocardial infarction on the EKG of VVI pacing | *[[McGill Case 42|The effect of an acute myocardial infarction on the EKG of VVI pacing]] | ||
Failure to pace or a recording artifact? This is a recording from a patient with a Medtronic implantable defibrillator which also functions as a VVI pacemaker. | *[[McGill Case 42|Failure to pace or a recording artifact? This is a recording from a patient with a Medtronic implantable defibrillator which also functions as a VVI pacemaker.]] | ||
Lead failure in a recently replaced VVI pacemaker. | *[[McGill Case 42|Lead failure in a recently replaced VVI pacemaker.]] | ||
Escape/capture bigemini | *[[McGill Case 42|Escape/capture bigemini]] | ||
A rate responsive pacemaker with a respiratory sensor | *[[McGill Case 42|A rate responsive pacemaker with a respiratory sensor]] | ||
A recording showing rate hysteresis | *[[McGill Case 42|A recording showing rate hysteresis]] | ||
pacing during ventricular fibrillation and failure to capture after a 360 joule shock. | *[[McGill Case 42|pacing during ventricular fibrillation and failure to capture after a 360 joule shock.]] | ||
===Pacing conduction patterns=== | ===Pacing conduction patterns=== | ||
A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle. | *[[McGill Case 42|A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle.]] | ||
Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation. | *[[McGill Case 42|Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation.]] | ||
A tracing from a patient with Mobitz I AV block where the AV conduction stops with VDD pacing even with a long sensed to paced interval of 300ms. | *[[McGill Case 42|A tracing from a patient with Mobitz I AV block where the AV conduction stops with VDD pacing even with a long sensed to paced interval of 300ms.]] | ||
===Pacemaker interactions=== | ===Pacemaker interactions=== | ||
A patient with two pacemakers, a DDD and a VVI .R which is at end of life | *[[McGill Case 42|A patient with two pacemakers, a DDD and a VVI .R which is at end of life]] | ||
Myopotential inhibition of a VVI.R pacemaker | *[[McGill Case 42|Myopotential inhibition of a VVI.R pacemaker]] | ||
Suppression of a VVI pacemaker with an external pacemaker | *[[McGill Case 42|Suppression of a VVI pacemaker with an external pacemaker]] | ||
===Pacemaker Pacing Artifacts=== | ===Pacemaker Pacing Artifacts=== | ||
Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation. | *[[McGill Case 42|Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation.]] | ||
Unipolar ventricular paced rhythm with atrial flutter | *[[McGill Case 42|Unipolar ventricular paced rhythm with atrial flutter]] | ||
===Pacemaker Follow-up=== | ===Pacemaker Follow-up=== | ||
=====Unusual rhythms===== | =====Unusual rhythms===== | ||
Bigemini with magnet over the pacemaker | *[[McGill Case 42|Bigemini with magnet over the pacemaker]] | ||
Bigemini with atrial threshold testing | *[[McGill Case 42|Bigemini with atrial threshold testing]] | ||
conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm | *[[McGill Case 42|conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm ]] | ||
====Threshold Testing==== | ====Threshold Testing==== | ||
3 lead rhythm strip with DDD pacemaker and normal magnet response | *[[McGill Case 42|3 lead rhythm strip with DDD pacemaker and normal magnet response]] | ||
Pulse amplitude threshold testing for a ventricular pacemaker | *[[McGill Case 42|Pulse amplitude threshold testing for a ventricular pacemaker]] | ||
Atrial threshold testing | *[[McGill Case 42|Atrial threshold testing]] | ||
Atrial threshold testing in a DDD pacer using the AAI mode | *[[McGill Case 42|Atrial threshold testing in a DDD pacer using the AAI mode]] | ||
Atrial threshold testing in a model 2102 pacemaker | *[[McGill Case 42|Atrial threshold testing in a model 2102 pacemaker]] | ||
PVCs interfering with ventricular threshold testing | *[[McGill Case 42|PVCs interfering with ventricular threshold testing]] | ||
The effect of a long AV interval on atrial threshold testing of a DDD Pacer | *[[McGill Case 42|The effect of a long AV interval on atrial threshold testing of a DDD Pacer]] | ||
Threshold testing inducing asystole in a 21 year old patient with congenital complete heart block. | *[[McGill Case 42|Threshold testing inducing asystole in a 21 year old patient with congenital complete heart block.]] | ||
Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other | *[[McGill Case 42|Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other]] | ||
====Strength duration curves==== | ====Strength duration curves==== | ||
A strength/duration curve from an atrial lead. | *[[McGill Case 42|A strength/duration curve from an atrial lead.]] | ||
A strength/duration curve from a ventricular lead. | *[[McGill Case 42|A strength/duration curve from a ventricular lead.]] | ||
====Time dependent capture==== | ====Time dependent capture==== | ||
====Pacemaker system failure==== | ====Pacemaker system failure==== | ||
Pacemaker pacing failure and Mobitz II A/V block in a patient with a history of Torsade de Pointe and three degree heart block. | *[[McGill Case 42|Pacemaker pacing failure and Mobitz II A/V block in a patient with a history of Torsade de Pointe and three degree heart block.]] | ||
A patient with a failing ventricular lead due to a subclavian crush. | *[[McGill Case 42|A patient with a failing ventricular lead due to a subclavian crush.]] | ||
====Trans-telephonic EKG recordings==== | ====Trans-telephonic EKG recordings==== | ||
Trans-telephonic pacemaker check failure to capture | *[[McGill Case 42|Trans-telephonic pacemaker check failure to capture]] | ||
Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic. | *[[McGill Case 42|Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic.]] | ||
Trans-telephonic pacemaker check at the MUHC (instructions) | *[[McGill Case 42|Trans-telephonic pacemaker check at the MUHC (instructions)]] | ||
Trans-telephonic Audio recordings | |||
The EKG and sound of a Medtronic VVI.P pacemaker with the magnet applied near the end of the recording | ====Trans-telephonic Audio recordings==== | ||
Recording of end of life indication with magnet applied to VVI pacemaker | *[[McGill Case 42|The EKG and sound of a Medtronic VVI.P pacemaker with the magnet applied near the end of the recording]] | ||
A pacemaker that required inversion of the programming head for programming. The pacemaker could not be programmed in the usual manner in the pacemaker clinic. The pacemaker was implanted correctly with the conducting window toward the skin, but was a left-sided model which differed from the previous x-ray outline of the right-sided model. Having to invert the programming head suggests a problem with the programming head, inverted implantation of the pacemaker, or because the pacemaker electronics are functioning as a contra-lateral pacemaker. | *[[McGill Case 42|Recording of end of life indication with magnet applied to VVI pacemaker]] | ||
Lecture on pacemaker follow-up November 1998 | *[[McGill Case 42|A pacemaker that required inversion of the programming head for programming. The pacemaker could not be programmed in the usual manner in the pacemaker clinic. The pacemaker was implanted correctly with the conducting window toward the skin, but was a left-sided model which differed from the previous x-ray outline of the right-sided model. Having to invert the programming head suggests a problem with the programming head, inverted implantation of the pacemaker, or because the pacemaker electronics are functioning as a contra-lateral pacemaker.]] | ||
*[[McGill Case 42|Lecture on pacemaker follow-up November 1998]] | |||
===Defibrillation and Cardioversion=== | ===Defibrillation and Cardioversion=== | ||
====External Cardioversion/defibrillation==== | ====External Cardioversion/defibrillation==== | ||
Recording of a series of shocks for Atrial Flutter | *[[McGill Case 42|Recording of a series of shocks for Atrial Flutter]] | ||
Sinus pause post cardioversion for atrial fibrillation | *[[McGill Case 42|Sinus pause post cardioversion for atrial fibrillation ]] | ||
An irregular rhythm after cardioversion for atrial fibrillation | *[[McGill Case 42|An irregular rhythm after cardioversion for atrial fibrillation]] | ||
pacing during ventricular fibrillation caused by cardioversion and failure to capture after a 360 joule shock. | *[[McGill Case 42|pacing during ventricular fibrillation caused by cardioversion and failure to capture after a 360 joule shock.]] | ||
====Implantable Defibrillators==== | ====Implantable Defibrillators==== | ||
Recording from a device during a spontaneous episode of ventricular fibrillation. | *[[McGill Case 42|Recording from a device during a spontaneous episode of ventricular fibrillation.]] | ||
P.A. chest film of a patient with an implantable defibrillator and an epicardial patch and S.V.C. spring electrode. | *[[McGill Case 42|P.A. chest film of a patient with an implantable defibrillator and an epicardial patch and S.V.C. spring electrode.]] | ||
=====Threshold Testing===== | =====Threshold Testing===== | ||
Defibrillation threshold testing of an implantable defibrillator (successful) followed by ventricular paced rhythm. | *[[McGill Case 42|Defibrillation threshold testing of an implantable defibrillator (successful) followed by ventricular paced rhythm.]] | ||
Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. | *[[McGill Case 42|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm.]] | ||
Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. Recorded using an external defibrillator. | *[[McGill Case 42|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. Recorded using an external defibrillator.]] | ||
===EKG Recordings=== | ===EKG Recordings=== | ||
An electrocardiogram from a patient with a cardiac myoplasty stimulator. | *[[McGill Case 42|An electrocardiogram from a patient with a cardiac myoplasty stimulator.]] | ||
A problem with atrial capture with a dual chamber pacemaker with a long A/V interval. | *[[McGill Case 42|A problem with atrial capture with a dual chamber pacemaker with a long A/V interval.]] | ||
A patient post pacemaker implant. for syncope | *[[McGill Case 42|A patient post pacemaker implant. for syncope]] | ||
A rate responsive pacemaker with respiratory sensor An ECG strip from the pacemaker clinic. | *[[McGill Case 42|A rate responsive pacemaker with respiratory sensor An ECG strip from the pacemaker clinic.]] | ||
A patient post DDD pacemaker implant ECG strip and images from a patient post DDD pacemaker implant. | *[[McGill Case 42|A patient post DDD pacemaker implant ECG strip and images from a patient post DDD pacemaker implant.]] | ||
Patient with perforation of a temporary transvenous pacemaker Three EKGs and X-ray | *[[McGill Case 42|Patient with perforation of a temporary transvenous pacemaker Three EKGs and X-ray.]] | ||