Protocol: Temporary Pacemaker Verification and Troubleshooting

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posted on 2022-10-06, 18:44 authored by Jill Ley

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Determining the Stimulation Threshold

NOTE: a paced rhythm must be present and patient stable
From 100% pacing, gradually decrease output for A or V, while watching monitor until you lose capture
Now gradually increase output until 1:1 capture returns – this is the stimulation threshold
This is the lowest amount of energy that will reliably capture the heart and pace
Set mA 1.5-3 times above this threshold value for safety
Repeat for other circuit (A or V)
Note: the stimulation threshold should be checked DAILY by the MD/NP when pacing is in use; in the event  the threshold value is rising, discuss with surgeon to determine if alternative pacing system is needed

Determining the Sensing Threshold

Note: the patient must have an underlying rhythm and tolerate a brief period without pacing to perform
Set RATE at least 10 bpm below patient’s intrinsic heart rate (to allow sensing)
Set OUTPUT at 0.1 mA (to avoid competitive pacing when device is made asynchronous briefly)
Highlight SENSITIVITY (under Menu 1)
Decrease SENSITIVITY: Slowly turn dial counter-clockwise until pace indicator flashes regularly (asynchronously)
Increase SENSITIVITY: Slowly turn dial clockwise until sense indicator flashes again (when sensing resumes, this is the sensing threshold – the smallest complex that is reliably recognized, thus inhibiting the device)
Set SENSITIVITY < half this threshold value for safety
Repeat for other circuit (A or V)
Restore previous rate and output values

Rapid Atrial (Overdrive) Pacing – PERFORMED BY MD/NP/CNS ONLY

Used to “overdrive pace” and terminate some atrial reentrant tachyarrhythmias, especially atrial flutter
ALWAYS VERIFY correct wire connections to avoid stimulating the ventricles at a rapid rate!
Set maximal atrial output to promote capture (20 mA)
Go to RAP menu (press MENU button three times)
Dial in RAP rate 10-40 bpm above intrinsic atrial rate (default = 320)
From RAP menu: press and hold SELECT button
Rapid pacing will be delivered via atrial circuit
Assess monitor for atrial “capture” at rapid rate
Abruptly discontinue pacing by releasing SELECT button
Examine rhythm and repeat if unsuccessful, consider: increasing rate and/or duration of stimulus, or gradually reducing pacing rate while holding SELECT