Dysrhythmias

Question 0

Implantable cardioverter - defibrillator description

Answer 0

Batterey-powered pulse generator implanted subcutaneously, usually in the left pectoral region.

ICD sensing system monitors the heart rate and rhythm and identify VF or VT

iCD are equipped with anthitachycardia and antibradycardia pacemaker.

Question 1

Implantable Cardioverter- Defibrillator indication

Answer 1

1- who have survived SCD
2- have spontaneous sustained ventricular tachycardia
3- have syncope with inducible VT or VF during EPS
4- are at high risk for future life threatening dysrhythmias ( have cardiomyopathy)

Question 2

Implantable Cardioverter - Defibrillator (ICD) patient teaching

Answer 2

1. Follow up with cardiologist for routine check of the function of the ICD
2. Report any signs of infection at incision site immediately ( redness, swelling, drainage, fever)
3. Keep incision dry for 4 days after insertion or as instructed
4. Avoid lifting arm on ICD side above shoulder until approved
5. Discuss resuming sexual activity with cardiologist; usually safe to resume sexual activity after the incision is healed
6. Avoid driving until clear by cardiologist
7. Avoid direct blow to ICD site
8. Avoid large magnet and strong magnetic field
9. Should not have a magnetic resonance imaging (MRI)
10. Air travel is not restricted, but be aware of metal detector,
11. Avoid standing near antitheft device in stores and public building
12. If your ICD fire, call the cardiologist immediately
13. If ICD fire and you feel sick, contact the emergency medical services
14. Always carry the ICD identification card and a current list of your medication
15. Encourage the family to learn CPR.

Question 3

Permanent pacemaker

Answer 3

1. Pulse generator is internal and surgically implanted in a subcutaneous pocket below the clavicle, or over the pectoral muscle in the patient nondominant side
2. The leads are passed tranvenously to the right atrium and/ or one or both ventricles and attached to powered source
3. Indication for permanent pacemakers
   Acquired AV block
   Second degree AV block
   Third degree AV block
   Atrial fibrillation with a slow ventricular response
   Bundle branch block
   Cardiomyopathy: dilated, hypertrophic
   Heart failure
   SA node dysfunction
   Tachydysrhythmias (e.g. Ventricular tachycardia)

Question 4

Temporal pacemaker

Answer 4

Temporary pacemaker is one that has power source outside the body. There are three types:

1. A transvenous pacemaker
2. Epicardial pacing
3. A transcutaneous pacemaker.