I have been in nursing for 35 years and have worked in a variety of settings including hospice, long term care, med-surg, supervision, cath lab, ER, special procedures and critical care. I enjoy working as a float nurse because it gives me a variety of clinical experiences. I am also a CPR, ACLS, and PALS instructor at our local hospital.
Wednesday, February 28, 2018
Pacemaker: Failure to Sense
This patient has a dual chambered pacemaker. He has converted to an atrial fibrillation and it appears that the pacemaker is having some sensing issues with the rhythm. I am not sure if it was a problem with the atrial sensing or the ventricular sensing. We had the Medtronic representative to come and troubleshoot the pacemaker but I did not hear what the report of the findings were.
This first page shows normal functioning pacemaker
This second page shows some sensing issues. In the first three complexes the Atrial sensing is not consistent. The patient has a run of non-sustained VT. The pacemaker spikes follow the QRS complexes of the VT rhythm.
In this page the QRS complexes follow the QRS complexes. We don't know if the pacemaker spikes are from the atria or ventricles.