By Charles J. Love
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Extra info for Cardiac Pacemakers and Defibrillators, 2nd Edition
The device paces at 70 bpm until inhibited by a sensed beat (5th beat on the top strip). It does not begin to pace again until the patient’s intrinsic rate falls to 50 bpm (3rd beat on the bottom strip). The pacemaker then paces at 70 bpm until another intrinsic beat is sensed (last beat on the bottom strip), at which time the hysteresis rate of 50 bpm is restored. not the case. As noted in Chapter 2, sensing of an intrinsic beat may not occur until late in the complex. Thus, even though the intrinsic QRS has started, the pacemaker may deliver an output as programmed since the intrinsic depolarization did not reach the electrode by the time the paced output is due to occur.
In atrial pacemakers the refractory period also prevents sensing of the far-field R-wave or T-wave. Use of unnecessarily long refractory periods may prevent sensing of an early intrinsic beat such as a PAC or PVC (Fig. 3). In some devices the first part of the refractory period may be an adjustable “Blanking Period”, during which no sensing at all occurs, followed by the remainder of the refractory period during which sensing occurs for diagnostic purposes only. The most common single chamber mode is the VVI mode (actually VVIR, but this will be described later).
The first method of changing a device setting required placing a triangular needle through the skin into a receptacle on the pacemaker to make the adjustment. Shortly thereafter magnetic fields were used. Finally radiofrequency transmissions became the method that is used on all devices today. As will be discussed later, magnets still have some uses to change device behavior or to trigger recording of events. Programmability provides flexibility to decrease battery drain, correct abnormal device behavior, and to adapt the device to a patient’s specific and changing needs.