| PURPOSE: To
outline the procedure for using the Medtronic A-V
Sequential Pacemaker. OBJECTIVES:
- To
provide a variety of temporary modalities, i.e.
asynchronous atrial or ventricular pacing, demand
ventricular pacing, asynchronous, or demand A-V
sequential pacing.
- To
pace the atrium and ventricles in sequence,
thereby allowing for more atrial contribution to
ventricular filling and normal conduction to
ventricles when the A-V node is conducting
normally.
- The dual-chamber generator can be
used as a single-chamber generator; however, dual
chamber asynchronous pacing can be performed.
This pacemaker senses only ventricular activity
but is capable of pacing both the atrium and the
ventricle.
INDICATIONS:
Symptomatic bradycardia; symptomatic bradycardia, and
varying degrees of A-V block in association with acute
myocardial infarction, and electrophysiological studies.
CONTRAINDICATIONS:
A-V sequential pacing does not depend on a functioning AV
conduction system; therefore, there are no absolute
contraindications to its use. In the presence of
fibrillation and flutter, atrial capture is usually not
possible.
EQUIPMENT:
- Atrial
and ventricular pacing wires
- A-V
pulse generator
- Equipment
per Infection Control SOP for Central Line
Insertions
- EKG
with recorder
- Defibrillator
- Emergency
cart.
PROCEDURE:
ACTION
|
RATIONALE
|
| 1. Follow
procedure as in transvenous pacemaker insertion. |
1. Procedure same
except for connecting of electrode to pacemaker
generator. |
| 2. Connect atrial
electrode to atrial output terminals, connecting
positive and negative electrode terminals to
respective positive and negative output terminals. |
2. Secure
connections are essential for proper conduction
of pacemaker energy. |
| 3. Connect
ventricular electrode to ventricular output
terminals, connecting positive and negative
electrode terminals to respective positive and
negative output terminals. |
3. Secure
connections are essential for proper sensing and
conduction of pacemaker energy. |
| 4. Set A-V
interval control at desired level. |
4. Usually set to
the normal PR interval. In patients with
intermittent second degree block, the A-V
interval is set above the patient’s normal
PR interval, allowing for normal conduction as
well. |
| 5. Set remainder
of settings as described in transvenous pacing
procedure. |
5. Set fast
enough to optimize cardiac output and blood
pressure without causing myocardial ischemia. |
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This page last updated 07/25/10
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