Thank you for posting this. I had a patient who was DDD paced and he kept dropping pressures into the 70s/50s. My first 12 lead said he was in a fib and when you explain it this way it helps me understand why I wasn’t seeing pacer spikes. It’s amazing how much atrial kick does to help pressures. I’m not sure what ended up happening with the patient but at shift change there was orders to interrogate. Thanks again!
Maaaaaannnnnn lol 2nd day as an RN today... had a patient on a pacemaker and a student nurse that was shadowing me! Glad I saw this video before work to refresh myself on the different modes and more lol 😭
I implanted a St. Jude St. Jude Microny 2525t single chamber in 2015 in 2020 I did the normal check and it indicated the battery at 2.78 V can it be normal? is it still new? bless you!
Can you explain why DDD cannot be used in a patient with AF, and why the pacemaker must switch to DDI? I am not understanding why this is the case. In DDD, the pacemaker will inhibit itself if the ventricles are already firing in response to the AF RVR. Certainly if a patient is in AF RVR, the DDD mode will automatically not V-pace the heart. Is it not just possible to set the upper limit to 60, and keep the pacemaker in DDD mode, so that if a patient in AF goes into RVR the pacemaker inhibits by its settings, but if the patient develops AF with SVR the pacemaker will cause ventricular depolarization after a 1-second delay from atrial depolarization? Why does the ventricle need to be ablated before DDD mode can be safe for patients with AF?
Thank you very much for your brilliant videos! If everybody who permanently needs a pacemaker would get a DDD because it can do everything... is there any medical argument against it?
The argument would be lower longevity because of the battery usage requiring more replacements. But nowadays the modes can be adjusted through a programmer. I am not sure but I believe some pacemakers can change their own setting if an event is detected.
I guess that when a patient is having lots of premature ventricular complexes/"pvc's" a sensing pacemaker could get confused and/or the cardiac output could decrease if the pvc's are not producing pulse waves because the (left) ventricle didn't have time to fill? (But the pvc's are delaying the next paced beat the same way that a beat that raised a pulse wave would have)
Yes, this is a potential problem that can happen. The first line intervention would be to suppress the PVCs with a beta blocker. There aren't really great strategies to mitigate this with only changes to pacemaker programming.
My wife is 29 years old 110 lb 5 foot 6 and she had to get a pacemaker put in about 3 or 4 months ago cuz her heart was randomly stopping it was Sino something. Today she went to the doctor and they turn down the volume on her pacemaker. Do you have any idea what they did by turning down the volume?
I can't give specific, individualized medical advice on here, and I recommend discussing any questions directly with her cardiologist. Having said that, by "turning down the volume", the cardiologist most likely was referring to turning down the "output". If this was the case (and that's a big "if", which is why you should check with the cardiologist), the most likely explanation is that when the pacemaker thresholds were tested to see how much current was necessary to pace her heart, the previous output setting was higher than necessary. This isn't generally dangerous - it just drains the battery faster. So by turning down an unnecessarily high output, it extends the length of time until a person needs their pacemaker generator (which includes the battery) changed.
My father had a pacemaker implanted due to complete heart block. He fainted 4 times before the pacemaker was implanted. 6 months after pacemaker surgery he experienced some dizziness as he experienced before the syncope but he did not faint. Within a few minutes he was back to normal. Does that mean the pacemaker is working well?
I'm sorry, but I can't offer specific, individualized medical advice here. I recommend your father speak with his cardiologist. Luckily, pacemakers have a variety of data that gets recorded, so his cardiologist might be able to download that information to let him know what his underlying rhythm is, and how often the pacemaker needs to "kick in".
Thanks for the suggestion, but unfortunately, I don't do any actual programming of the devices myself. Our cardiologists would have a heart attack if they heard that a hospitalist was reprogramming their patients' pacemakers! ;) EDIT: I'll add that every device manufacturer (e.g. Medtronic, Boston Scientific, Abbott - formerly St. Jude) has a different system/user interface for programming. So to show what the screen actually looks like on the programmer, you'd need a separate video for each company.
VVI means that the pacemaker's firing of a single ventricular lead is inhibited (as in momentarily blocked) if it senses the ventricle has already depolarized. AAI means that the pacemaker's firing of a single atrial lead is inhibited if it senses the atria has already depolarized.
Doctor just told me my heart rate has dropped to zero and that it wont work again, so basically only the pacemaker is what's keeping me alive. Do you have any reading material for people in my condition? Thank you!
@Sonia Barriga Muñoz.... youre so brave....i hope i have youre braveness...im only 33 years old and i have sinus bradycardia.... im afraid of having a pace maker...im too young....i wanna live a long life...😥😥😥...am dealing with anxiety...im so anxious...😢😢😢im always crying....
my heart stops 6-8secs like 20x a day but the episodes were far apart. 2019 i had a emergency dual chamber PM implant coz the intervals of the episodes were just to close that before my heart can recover it ill stop again. without my PM my heart rate is just 19-29....so basically i'm battery operated now. i'm slowly going back to riding my mtb on light trails and playing ball games.
Please help, my husband got pacemaker 2 months ago. The reason why he needed a pacemaker because low heart rates 48/min and everything else was fine with his heart . Right after he got the pacemaker he started experience over 125/min heart rates to 200/min. Went to emergency and they said he has a atrial fibrillation. Before pacemaker he had three years monitor installed to check his heart rate and was always low. It never detected atrial fibrillation. Do you think that pacemaker has something to do with that or the pacemaker is not installed appropriate .
I can't give specific, individualized medical advice here, and I recommend your husband speak to his cardiologist about this. Having said that, I am unaware of any data that the act of getting a pacemaker, in itself, increase the risk of developing atrial fibrillation. However, there are certain pacing modes (VVI) that are associated with developing a-fib.
@@StrongMed I forgot to mention last visit at his cardiologist’s office it showed some arrows on the pacemaker monitor. The Dr. didn’t explain why. He said that he’s going to adjust the mode but he keeps repeating that his heart condition has nothing to do with the pacemaker. I am not 100% convinced.
It depends on the circumstances. If the myocardial infarction affected the sinus or AV nodes (i.e. part of the conduction system), then a pacemaker could prevent an unusually slow rhythm from occurring. If the myocardial infarction resulted in impaired contractile force (i.e. a low ejection fraction), a biventricular pacemaker can be used to help improve contraction (if there is evidence of impaired electrical conduction through the ventricles), but this is only done after at least 3 months of optimal medical therapy to see if the problem can be addressed without the need for a pacemaker. Also, in a patient with impaired ejection fraction after MI and a period of medical optimization, an ICD is often implanted as well, which will provide an electrical shock (a.k.a. defibrillation) in the event of a potentially fatal heart rhythm.
Sir. I would like to thank you so much. And i would like if it is possible tthat you make a video about statistics like p value And confidence level and so on. I have difficulties of interpreting the results of the studies and trials. Thank you again
Implantation of pacemakers are usually done on the left, even in left-handed individuals, primarily because it is a technically easier procedure since the leads (i.e. wires) are advanced into the right side of the heart as one continuous curve. When placing devices in the right upper chest, the leads need to make several slight turns within the blood vessels. There are some exceptions to this placement preference - for example, if the patient has an AV fistula for dialysis in the L arm, or if there is an anatomic obstruction such as a left subclavian thrombus, the cardiologist would typically place the device on the right side. ICDs are (almost) always placed on the left because the "can" (i.e. the generator) itself is part of the defibrillation circuit, and the closer proximity to the heart on the left is believed to increase the probability of a successful defibrillation.
@@StrongMed could there potentially be any complications from putting them on the right side? My pacemaker is on the right. It's there because of an infection from the first one that was on the left.
@@kooldesign4u Because the procedure is *slightly* technically more difficult to place them on the right, it would be expected that the immediate complication rate from right-sided placement would be *slightly* higher. But these kinds of complications are still rare, and would usually be immediately apparent within hours (or even minutes) from placement. I do not know of any difference in medium and long-term complication rates (e.g. infections) between the right and left sided placement.
Sir...I completed my internal medicine residency in India.... I'm interested in doing electrophysiology fellowship in USA sir ...what is the procedure sir Pls give some advice
I guess you could say this video was.... well paced ⚡️❤️
Bhul b
@@upendranathverma1740 d
Ha,ha ha, god pointed!😁
did it... make your heart flutter.. after all these years?
Excellent materials with clear explanations.
1000 times Better than just reading the text book. Thank you so much for your great work.
Glad it was helpful!
Thank you for posting this. I had a patient who was DDD paced and he kept dropping pressures into the 70s/50s. My first 12 lead said he was in a fib and when you explain it this way it helps me understand why I wasn’t seeing pacer spikes. It’s amazing how much atrial kick does to help pressures. I’m not sure what ended up happening with the patient but at shift change there was orders to interrogate. Thanks again!
Your videos are just awesome, Please keep up the good work 👍
Awesome and very helpful video! I've referred to it more than once.
Accurately sensed & Correctly paced one👍🏾
Thanks for the awesome video!!
Thank you! The video was extremely helpful!
amazing, thank you so much for such a clear video
remarkable video, thanks a lot!
It really helps to refresh your basic
So good, thanks!
These series you made on pacemakers is
amazing !
Thankyou so much. It was very helpful for my Biomedical Instrumentation Subject. From #india#Assam
Maaaaaannnnnn lol 2nd day as an RN today... had a patient on a pacemaker and a student nurse that was shadowing me! Glad I saw this video before work to refresh myself on the different modes and more lol 😭
I'm glad it was helpful. Good luck in your new career!
Well done..
Brilliant
Thanks a lot
brilliant
I implanted a St. Jude St.
Jude Microny 2525t single chamber in 2015
in 2020 I did the normal check and it indicated the battery at 2.78 V can it be normal?
is it still new?
bless you!
👍
Thank you so much, where can i donate to your chanel?
thanks m8
why will we give a VVI mode pacemaker for chronic AF?
Can you explain why DDD cannot be used in a patient with AF, and why the pacemaker must switch to DDI? I am not understanding why this is the case. In DDD, the pacemaker will inhibit itself if the ventricles are already firing in response to the AF RVR. Certainly if a patient is in AF RVR, the DDD mode will automatically not V-pace the heart. Is it not just possible to set the upper limit to 60, and keep the pacemaker in DDD mode, so that if a patient in AF goes into RVR the pacemaker inhibits by its settings, but if the patient develops AF with SVR the pacemaker will cause ventricular depolarization after a 1-second delay from atrial depolarization? Why does the ventricle need to be ablated before DDD mode can be safe for patients with AF?
Thanks
Thank you very much for your brilliant videos!
If everybody who permanently needs a pacemaker would get a DDD because it can do everything... is there any medical argument against it?
The argument would be lower longevity because of the battery usage requiring more replacements. But nowadays the modes can be adjusted through a programmer. I am not sure but I believe some pacemakers can change their own setting if an event is detected.
Is implantation of the lead system more involved/difficult?
Hi, great presentatión. Can you share the slides?
I guess that when a patient is having lots of premature ventricular complexes/"pvc's" a sensing pacemaker could get confused and/or the cardiac output could decrease if the pvc's are not producing pulse waves because the (left) ventricle didn't have time to fill? (But the pvc's are delaying the next paced beat the same way that a beat that raised a pulse wave would have)
Yes, this is a potential problem that can happen. The first line intervention would be to suppress the PVCs with a beta blocker. There aren't really great strategies to mitigate this with only changes to pacemaker programming.
My wife is 29 years old 110 lb 5 foot 6 and she had to get a pacemaker put in about 3 or 4 months ago cuz her heart was randomly stopping it was Sino something. Today she went to the doctor and they turn down the volume on her pacemaker. Do you have any idea what they did by turning down the volume?
I can't give specific, individualized medical advice on here, and I recommend discussing any questions directly with her cardiologist.
Having said that, by "turning down the volume", the cardiologist most likely was referring to turning down the "output". If this was the case (and that's a big "if", which is why you should check with the cardiologist), the most likely explanation is that when the pacemaker thresholds were tested to see how much current was necessary to pace her heart, the previous output setting was higher than necessary. This isn't generally dangerous - it just drains the battery faster. So by turning down an unnecessarily high output, it extends the length of time until a person needs their pacemaker generator (which includes the battery) changed.
My father had a pacemaker implanted due to complete heart block. He fainted 4 times before the pacemaker was implanted. 6 months after pacemaker surgery he experienced some dizziness as he experienced before the syncope but he did not faint. Within a few minutes he was back to normal. Does that mean the pacemaker is working well?
I'm sorry, but I can't offer specific, individualized medical advice here. I recommend your father speak with his cardiologist. Luckily, pacemakers have a variety of data that gets recorded, so his cardiologist might be able to download that information to let him know what his underlying rhythm is, and how often the pacemaker needs to "kick in".
Well organised video but on screen programming video make it easy for us
Thanks for the suggestion, but unfortunately, I don't do any actual programming of the devices myself. Our cardiologists would have a heart attack if they heard that a hospitalist was reprogramming their patients' pacemakers! ;)
EDIT: I'll add that every device manufacturer (e.g. Medtronic, Boston Scientific, Abbott - formerly St. Jude) has a different system/user interface for programming. So to show what the screen actually looks like on the programmer, you'd need a separate video for each company.
@@StrongMed
Thanks 🙏 for your understanding and answering my questions …
You are right cardiologists I try my best for learning this
Thank you this one is good video. I always see VVI, what does mean inhibit?
VVI means that the pacemaker's firing of a single ventricular lead is inhibited (as in momentarily blocked) if it senses the ventricle has already depolarized.
AAI means that the pacemaker's firing of a single atrial lead is inhibited if it senses the atria has already depolarized.
@@StrongMed The pacemaker inhibit, so the pacemaker not fire?
@@judypeng4748 Yes, that's correct. It does not fire for a single heart beat.
@@StrongMed thank you! So if I want to fire the pacemaker, I need to adjust the pacemaker to turn on make it fire
A few days ago i was diagnosed with av blok myself. 1st degree and 2nd degree. I'm afraid i might need a pacemaker myself
Doctor just told me my heart rate has dropped to zero and that it wont work again, so basically only the pacemaker is what's keeping me alive.
Do you have any reading material for people in my condition?
Thank you!
@Sonia Barriga Muñoz.... youre so brave....i hope i have youre braveness...im only 33 years old and i have sinus bradycardia.... im afraid of having a pace maker...im too young....i wanna live a long life...😥😥😥...am dealing with anxiety...im so anxious...😢😢😢im always crying....
my heart stops 6-8secs like 20x a day but the episodes were far apart. 2019 i had a emergency dual chamber PM implant coz the intervals of the episodes were just to close that before my heart can recover it ill stop again. without my PM my heart rate is just 19-29....so basically i'm battery operated now. i'm slowly going back to riding my mtb on light trails and playing ball games.
Hi, how are you now?
Please help, my husband got pacemaker 2 months ago. The reason why he needed a pacemaker because low heart rates 48/min and everything else was fine with his heart . Right after he got the pacemaker he started experience over 125/min heart rates to 200/min. Went to emergency and they said he has a atrial fibrillation. Before pacemaker he had three years monitor installed to check his heart rate and was always low. It never detected atrial fibrillation. Do you think that pacemaker has something to do with that or the pacemaker is not installed appropriate .
I can't give specific, individualized medical advice here, and I recommend your husband speak to his cardiologist about this. Having said that, I am unaware of any data that the act of getting a pacemaker, in itself, increase the risk of developing atrial fibrillation. However, there are certain pacing modes (VVI) that are associated with developing a-fib.
@@StrongMed I forgot to mention last visit at his cardiologist’s office it showed some arrows on the pacemaker monitor. The Dr. didn’t explain why. He said that he’s going to adjust the mode but he keeps repeating that his heart condition has nothing to do with the pacemaker. I am not 100% convinced.
Depends on age of the patient. If he's having Atrial fibrillation, mode of pacemaker shud be VVI
Having a pacemaker implanted next week. I’m 73 with chronic afib and high heart rate. Three ablations and multiple cardio version no help.
What dostana beetween metal detector n pacemaker
Can a pacemaker do the job of regulating heart beat or at least overall improve the heart after Myocardial infarction???
It depends on the circumstances.
If the myocardial infarction affected the sinus or AV nodes (i.e. part of the conduction system), then a pacemaker could prevent an unusually slow rhythm from occurring. If the myocardial infarction resulted in impaired contractile force (i.e. a low ejection fraction), a biventricular pacemaker can be used to help improve contraction (if there is evidence of impaired electrical conduction through the ventricles), but this is only done after at least 3 months of optimal medical therapy to see if the problem can be addressed without the need for a pacemaker.
Also, in a patient with impaired ejection fraction after MI and a period of medical optimization, an ICD is often implanted as well, which will provide an electrical shock (a.k.a. defibrillation) in the event of a potentially fatal heart rhythm.
Sir. I would like to thank you so much. And i would like if it is possible tthat you make a video about statistics like p value And confidence level and so on. I have difficulties of interpreting the results of the studies and trials. Thank you again
I'd love to cover biostatistics on this channel, but it's a monster of a topic. Unfortunately, I'm not convinced I could do the topic justice.
@@StrongMed sir could you please consider a video on approach to altered mental status.
@@shubhamvr05 It's on my short list! (i.e. hopefully will get to it this fall)
Sir,can you please tell me the difference of implant in the right or left
Implantation of pacemakers are usually done on the left, even in left-handed individuals, primarily because it is a technically easier procedure since the leads (i.e. wires) are advanced into the right side of the heart as one continuous curve. When placing devices in the right upper chest, the leads need to make several slight turns within the blood vessels. There are some exceptions to this placement preference - for example, if the patient has an AV fistula for dialysis in the L arm, or if there is an anatomic obstruction such as a left subclavian thrombus, the cardiologist would typically place the device on the right side.
ICDs are (almost) always placed on the left because the "can" (i.e. the generator) itself is part of the defibrillation circuit, and the closer proximity to the heart on the left is believed to increase the probability of a successful defibrillation.
@@StrongMed could there potentially be any complications from putting them on the right side? My pacemaker is on the right. It's there because of an infection from the first one that was on the left.
@@kooldesign4u Because the procedure is *slightly* technically more difficult to place them on the right, it would be expected that the immediate complication rate from right-sided placement would be *slightly* higher. But these kinds of complications are still rare, and would usually be immediately apparent within hours (or even minutes) from placement.
I do not know of any difference in medium and long-term complication rates (e.g. infections) between the right and left sided placement.
Sir...I completed my internal medicine residency in India....
I'm interested in doing electrophysiology fellowship in USA sir ...what is the procedure sir
Pls give some advice
Would you share the slides?
This link should work: drive.google.com/file/d/1B3Jn_7KbJWtukSrCWcbpBSqi86it0PXw/view?usp=sharing
I much prefer the classical music
I do too, but I think we are both in the minority. ¯\_(ツ)_/¯
Strong Medicine I also enjoy classical music.
Not audible,, very low volume...
So quiet, turn op the microphone gain for future videos!
Great video otherwise, thanks for making it!