ECG Lesson in Advanced Pacemaker Troubleshooting
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- Опубліковано 17 вер 2024
- This advanced lesson is our 500th ChalkTalk on ECG Academy -- 10 years of Dr. Nick Tullo demonstrating to ECG readers how to analyze complex tracings like a Cardiac Electrophysiologist. Even physicians and seasoned ECG readers can learn from this complex pacemaker tracing.
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Excellent Case...Thanks for sharing 👍
You're welcome, Doc!
mind-blowing talk ! thank you , I hope I can be a great cardiologist like yourself
Hey, Thanks!!
Great one
Hey! Thanks Doc!!
Thanks, Dr. Nick Tullo. Great!
Thank you! I'm really glad you enjoyed it!
That was a wonderful explanation!
Well, thank you SO much! 🙂
Thanks
Would appreciate if have a video on pseudopseudofusion . thanks
Excellent as Usual . Thanks a lot for that great Work 500 Like
Thank you so much, Ahmed!! 🙂
Nice video Doctor! Would be nice to see a video of what you carry in your doctors bag 😊
What's a "doctors bag"? -- I stopped using one after I finished medical school!!
@@ECGDoc thank you for the reply doctor
Dont know if you know anything about his bundle pacing but In a dual chamber his bundle PM, what would be the cause of a qrs taking on the appearance of an M and being broad? Also if the his bundle is properly situated would the qrs be narrow? And what would cause a broad qrs with a his bundle lead?
Regina -- His bundle pacing is growing in popularity because of the potential restoration of a narrow QRS and avoidance of LV dyssynchrony. However, sometimes HBP leads don't capture properly and can result in a wider QRS. It is a work in progress, and with somewhat disappointing results because of late lead failure rates that are much higher than conventional pacers. Just wait until we have LBB pacing! Then things will really be confusing!
In the settings of PVARP. If a patient has a device that does this automatically, wouldnt it just do its "thing", and
PMT episodes without programming changes(for 3 whole years) would/should raise the suspicion of a defective atrial lead? And shouldn't short duration PMT be the first clue of a defective atrial lead because atrial false signals tend to occur irregularly, it wouldn't be apparent or suspected at the time of follow-up/interrogation?, unless the PMT was happening at time of interrogation
Hi, Regena! The PVARP occurs after every beat and can be programmed longer or shorter. It gets even more complicated because some pacers will automatically extend the PVARP after a PVC to ensure that PMT does not get started. Speaking of PMT, since this tracing shows atrial fib, PMT cannot occur. PMT occurs because of retrograde atrial events that are sensed and tracked, and yes, they can be triggered by atrial lead issues like undersensing or failure to capture, but in AF it's not even a consideration. But understanding the concept of the PVARP is important in analyzing pacer rhythms.
I am in the planning stage for my next Live Masterclass, which will be on complex pacemaker troubleshooting. Maybe you can plan on attending...?
@@ECGDoc yes I'd love to. So if a patient is in a normal atrial paced rhythm, PMT can occur? And if it's short duration PMT, than would a lead malfunction such as a microfracture be suspicious? I read an article that impedance and voltage could show normal on interrogation with a microfracture of the Atrial lead, so what tests would be done on interrogation to rule this out?
@@kooldesign4u It's a complex issue. It's not a harmful problem, and unless pt complains of palpitations or I see recorded "SVT" or atrial high-rate episodes that LOOK like PMT I don't worry about it. "Microfractures" generally are not clinically relevant unless significant lead dysfunction is noted. I'm talking clinical, every-day PPM / EP practice. Some academics may make more out of these theoretical issues than they're worth. Just my two cents...
@@ECGDoc I understand..oh and what would cause a patient without any known av block to pace at a high rate in the ventricles? While in a resting position? The rate is not exceeding the upper limit of the pacemaker.
@@kooldesign4u I'm not sure what you are asking. One example is what I show in this ChalkTalk -- the patient is in an arrhythmia (AF) that the pacemaker is "tracking" because in general pacers are designed to "keep up" with the atrial rate.
Hello sir my self himakanth my heart reat is between 35 to 40 most of the time is there is any canche like I can avoid pacrmaker and is there is any medication
I india. No doctors is giving medicine for me. And my age is 22. It's my request sir plz give some guidance
If you were a marathon runner, I would tell you a heart rate of 40 is fine. There is a condition known as congenital complete heart block, where a person is born with a very slow heart beat. If you are having symptoms of fatigue, shortness of breath at rest or with exertion, lightheadedness, or fainting, then you might need a pacemaker. If you have absolutely no symptoms, then maybe you don't need one at this time. I know it's difficult to see specialists in India but they do exist. See a cardiologist if you can.