If, on the other hand, the lead is in the LV, it will produce a right bundle branch block (RBBB) pattern. If the patient is unresponsive, slow the pacemaker to look for the presence of ventricular fibrillation, which can be masked by TCP artifact. The patient should be questioned regarding any known changes in the pacemaker settings since receiving the pacemaker card. (Courtesy of Medtronic, Inc., Minneapolis, MN.) A pneumothorax and/or hemothorax may be detected in patients whose pacemakers have been recently implanted. The magnet rate may be slower or faster than the program rate and depends on the model of the pacemaker. In other words, it indicates that there is enough energy in the spike to overcome the stimulation threshold. ), alternating with failure of capture. The patient should not be taking aspirin in the immediate postimplantation period unless authorized and/or prescribed by the Cardiologist. A history and physical examination should be performed while simultaneously obtaining a 12-lead electrocardiogram (ECG). Scher D: Troubleshooting pacemakers and implantable cardioverterdefibrillators. The code is generic in nature. Stimulation of the diaphragm may be caused by perforation of the right ventricular wall by the pacing wire and can occur with very few complications. It may be free-floating within the ventricle or may have perforated the ventricular wall. Ensure mechanical capture is present by confirming a pulse that matches the set pacemaker rate by palpation, echocardiogram, pulse oximetry, or arterial waveform. Anything that influences the rate and rhythm of occurrence of an activity or process. If you have mechanical capture, the pulse ox waveform should show definite pulses and the patient's ETCO2 should increase because of increased perfusion. Schematic of an electrocardiographic monitor strip demonstrating intermittent or erratic prolongation of the pacing spike interval. Failure to capture during the postimplantation period could result from an elevated voltage threshold for pacing due to tissue changes at the electrodemyocardium interface.10,11 The occurrence of postimplantation failure to capture typically occurs in the first few weeks after implantation. Copyright 2023 Allergic reactions to the pacemaker covering are very rare but have been reported. Electrocardiography in Emergency, Acute, and Critical Care, Critical Decisions in Emergency and Acute Care Electrocardiography, Chous Electrocardiography in Clinical Practice: Adult and Pediatric, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.