Pacemaker settings s/p hearts

[anesthccm]

Hello ! For all those who do hearts routinely , can you please tell a good resource or share whats your practice with pacemaker settings , I find it confusing.
I usually put them on DDD. but would like to learn more like which mode for which situation .
thnks !

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[vector2]

Hello ! For all those who do hearts routinely , can you please tell a good resource or share whats your practice with pacemaker settings , I find it confusing.
I usually put them on DDD. but would like to learn more like which mode for which situation .
thnks !

http://www.cardiacengineering.com/pacemakers-wallace.pdf

 

[anesthccm]

thanks i have read this before but want to know practically what mode in what situation and is it safe to put pt in DDD always ? even if you have just a wires or just v wires ?

 

[Wiscoblue]

Well if you have just a wires and your setting is on DDD, it is effectively AAI. And likewise, if you have just v wires, and the pacemaker is set to DDD, it is effectively VVI. I like to keep it on DOO until the sternal wires go in because bovie interferes a lot with DDD. You just have to set the rate a little higher than the intrinsic rate, if there is one.


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[anes121508]

Not an attending, but I've been taught asynchronous (VOO/DOO) until chest is closed (same reason as mentioned above).

In straight forward cases I've been taught to start at rate of 60 and slowly turn up the amplitude until obtaining capture. Then slowly turn up the rate (usually our surgeons like 80-90).

I've seen some surgeons do just v wires and sometimes put in a wires for patients that could use the extra ventricular filling and boost in cardiac output.

DDD/VVI once bovie is done and transporting to ctu (so no R on T).

I'm also interested in though as to other tips and pearls about pacing prior to coming off pump. Any advice or scenarios of what to watch out for would be greatly appreciated!

 

[OB1🤙]

The answer is that it depends.

It depends on the native electrical activity.

It depends on the adequacy of the native hemodynamics.

It depends on what perceived problem you're trying to fix by pacing.

Pacing after OHS is not a one-size-fits-all therapy.

Can you point to a specific situation you're not comfortable with?

 

[periopdoc]

Depends, but as a generic start, I put it in DOO rate of 80 until the sternum is wired closed then switch to DDI. I can't really comment beyond that unless you have a specific question.

 

[vector2]

Has anyone here actually encountered an R on T fib/arrest when the intrinsic rate climbed above the set rate in DOO mode?

 

[anesthccm]

so then whats the harm in putting on DDD and just have a or v wires as if forgotten to change the mode there shoundnt be r on t phenomenon with this setting ?

 

[drmwvr]

so then whats the harm in putting on DDD and just have a or v wires as if forgotten to change the mode there shoundnt be r on t phenomenon with this setting ?

DDD pacing with just an A wire is AAI, so no harm there.

DDD with just a V wire risks R on T event because of under sensing of a native QRS through post atrial ventricular blanking. Unless, that is, the device you're using won't let you pace DDD in the absence of an A wire.

Ours will allow DDD without A wires.

Not pacing at all is an option on occasion too. I do that frequently.

 

[OB1🤙]

My surgeons usually only put in pacer wires if I ask for them. For CABG, this is hardly ever, for AVR it's infrequent, for mitrals and other stuff is quite often.