Simple Control Of Implanted Patients

Abstract

The consultation of a paced patient with a cardio logist is part of the control procedure undertaken in collaboration with the practitioner and the implantat ion centre. Besides a usual cardiology consultation, some elements relative to the status of the implanted patient need to be added.The inspection will check the state of the skin close to the pace-maker and the absence of inflamm ation signs in the pocket. Such abnormalities, if detected early may be treated efficiently with a simple surgical intervention, whereas their spontaneo us evolutions may lead to the extenorisation of the pacemaker and the need for a re-implantation in a different site. Muscle pacing may be looked for around the can (unipoiar pacing), as well as diap hragmatic pacing, which may indicate lead perforat ion, or phrenic nerve pacing. The venous state of the upper limb needs to be checked, as a venous thrombosis may occur at a distance from the implant ation site.The role of the magnet allows a check of the function of the pacemaker in case of inhibition by a spontaneous rhythm superior to the basic frequency. It causes a switch to asynchronous pacing mode at a frequency which is usually higher than the basic frequency. On certain models, pacing parameters (amplitude, spike duration) may be modified during the magnet test. Any interpretation will have to take this into account. Certain models are equipped with tests of pacing threshold measurement, triggered by a certain time to manet application and causing the delivery of intensity spikes progressively decreasing, of a known value, which allows measurement of pacing thresholds (e.g., VARIO). The magnet ftcq uency is also a parameter allowing the control of battery waste. For safety reasâns, magnet application should only take place under control of a continuo usly recorded ECG.