2. How many people implantation
pacemaker every year in Taiwan ?
Statistics 2010 Taiwan Device Implantation
Units
4700
Pacemaker 4215
ICD 286
CRTD 64
CRTP 135
3. What Is a Pacemaker?
A pacemaker is a small device that's placed in the chest or
abdomen to help control abnormal heart rhythms. This
device uses electrical pulses to prompt the heart to beat
at a normal rate.
三部份所組成
由節律器（pulse generator ）
電極（electrode）電極的前端安置在心臟裡面
導線（lead）導線連接節律器與電極間，節律器以一定的速度
將電刺激傳到心臟，使心臟維持規律的跳動。
5. Pacemaker function
Most pacemakers perform four functions
• Stimulate cardiac depolarisation.
• Sense intrinsic cardiac function.
• Respond to increased metabolic demand by
providing rate-responsive pacing.
• Provide diagnostic information stored by the
pacemaker.
6. Indications for permanent cardiac pacing
• Sinus node dysfunction
• Atrioventricular (AV) block
• Ventricular tachycardia
• Carotid sinus hypersensitivity with recurrent syncope or
ventricular asystole >3 seconds.
• Neurocardiogenic syncope with
• associated documented bradycardia.
• Atrial fibrillation Symptomatic,drug-refractory atrial fibrillation
with co-existing sinus node disease (tachy-brady syndrome).
• Heart failure
• Hypertrophic cardiomyopathy There is some evidence it reduces
intra-left ventricular systolic pressure (Ritter 2005).
7. Single or dual-chamber pacing
Toff et al (2005)
found that dual-chamber
pacemakers tended to
prevent more subsequent
heart problems than
single-chamber ventricular
pacemakers.
9. Pre-implant preparation
Depression and anxiety are reported to be more common
in patients with permanent pacemakers than in the
general population (Duru et al 2001, Tagney 2010).
• Important sufficient information pre-operatively to
prevent any misconceptions
• suggested that pre-operative information should
include an explanation of why the pacemaker is
required, the different components of the pacemaker
(generator and lead), and the pre-operative routine.
• family should ideally be included in any discussions.
18. Undersensing : Pacemaker does not "see" the intrinsic beat,
and therefore does not respond appropriately
From http://www.pacemakerproject.com/treatments/tr_pacemaker_how.htm 2008/10/31
19. Oversensing : An electrical signal other than the
intended P- or R-wave is detected
From http://www.pacemakerproject.com/treatments/tr_pacemaker_how.htm 2008/10/31
24. Post-operative education
Wound care advice
• NICE (2008) recommends covering the wound
transparent dressing post-operatively for 48 hours
• Patients should be advised to look for wound
complications such as haematoma or infection sign
• Wearing sterile gloves dressing
• Do not touch wound and pacemaker
25. Post-operative education
Driving
• The Driver and Vehicle Licensing Agency
(2010)states that a car or motorbike cannot be
driven for at least one week post-pacemaker
insertion.
• ICD patient Recommendation 3-6 months
driving
26. Post-operative education
• Work
• when patients return to work as long as
they feel well enough to do so.
• activity in the first few weeks to
prevent lead dislodgement.
