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Case reports from Michael Rosengarten: Difference between revisions
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Case reports from Michael Rosengarten (view source)
Revision as of 06:52, 15 February 2012
, 15 February 2012→Cardiac Pacemakers:
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*[[McGill Case 97|A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.]] | *[[McGill Case 97|A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.]] | ||
==Cardiac Pacemakers== | |||
A review of cardiac pacing | A review of cardiac pacing | ||
Modes of cardiac pacing | Modes of cardiac pacing | ||
Definitions of different pacing modes | Definitions of different pacing modes | ||
===Examples of different pacing modes=== | |||
====DDD pacemakers==== | |||
DDD timing diagram in sinus rhythm with an AV delay of 80ms. | 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. | DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing. | ||
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Recording from the atrial lead of a patient with atrial fibrillation | Recording from the atrial lead of a patient with atrial fibrillation | ||
====Atrial pacing==== | |||
AAI with ladder diagram | AAI with ladder diagram | ||
AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia. | AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia. | ||
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An irregular rhythm with an atrial pacemaker. | An irregular rhythm with an atrial pacemaker. | ||
====Ventricular Pacing==== | |||
VVI with ladder diagram | VVI with ladder diagram | ||
Ventricular paced rhythm with atrial flutter | Ventricular paced rhythm with atrial flutter | ||
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pacing during ventricular fibrillation and failure to capture after a 360 joule shock. | pacing during ventricular fibrillation and failure to capture after a 360 joule shock. | ||
===Pacing conduction patterns=== | |||
A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle. | 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. | 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. | 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=== | |||
A patient with two pacemakers, a DDD and a VVI .R which is at end of life | A patient with two pacemakers, a DDD and a VVI .R which is at end of life | ||
Myopotential inhibition of a VVI.R pacemaker | Myopotential inhibition of a VVI.R pacemaker | ||
Suppression of a VVI pacemaker with an external pacemaker | Suppression of a VVI pacemaker with an external pacemaker | ||
===Pacemaker Pacing Artifacts=== | |||
Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation. | Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation. | ||
Unipolar ventricular paced rhythm with atrial flutter | Unipolar ventricular paced rhythm with atrial flutter | ||
===Pacemaker Follow-up=== | |||
=====Unusual rhythms===== | =====Unusual rhythms===== | ||
Bigemini with magnet over the pacemaker | Bigemini with magnet over the pacemaker | ||
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conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm | conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm | ||
====Threshold Testing==== | |||
3 lead rhythm strip with DDD pacemaker and normal magnet response | 3 lead rhythm strip with DDD pacemaker and normal magnet response | ||
Pulse amplitude threshold testing for a ventricular pacemaker | Pulse amplitude threshold testing for a ventricular pacemaker | ||
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Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other | Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other | ||
====Strength duration curves==== | |||
A strength/duration curve from an atrial lead. | A strength/duration curve from an atrial lead. | ||
A strength/duration curve from a ventricular lead. | A strength/duration curve from a ventricular lead. | ||
====Time dependent capture==== | |||
====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. | 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. | A patient with a failing ventricular lead due to a subclavian crush. | ||
====Trans-telephonic EKG recordings==== | |||
Trans-telephonic pacemaker check failure to capture | Trans-telephonic pacemaker check failure to capture | ||
Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic. | Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic. | ||
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Recording of end of life indication with magnet applied to VVI pacemaker | Recording of end of life indication with magnet applied to VVI pacemaker | ||
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. | 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. | ||
Lecture on pacemaker follow-up November 1998 | Lecture on pacemaker follow-up November 1998 | ||
===Defibrillation and Cardioversion=== | ===Defibrillation and Cardioversion=== | ||