Dr. Eric Silver, Associate Professor of pediatrics at Columbia University Medical Center, discusses temporary pacing in pediatric cardiology. Topics include common indications for temporary pacing, understanding pacing modes in pacemakers, different pacing methods and risk factors for rhythm disturbances after cardiac surgeries.
The main indications for acquiring temporary pacing in post-op patients are heart block, junctional bradycardia, and junctional tachycardia.
Troubleshooting and adjusting energy output are essential for addressing capturing and sensing issues in temporary pacing.
Deep dives
Temporary Cardiac Pacing in Pediatric Patients
Temporary cardiac pacing is discussed in this episode, focusing on the post-operative care of children who require pacing after cardiac surgeries. The main indications for acquiring temporary pacing in post-op patients are heart block, junctional bradycardia, and junctional tachycardia. The episode also covers the components of temporary pacemakers, including the placement of wires on the outside of the heart and the importance of correct wiring to ensure proper pacing. Sensing and capturing issues are addressed, emphasizing the need for troubleshooting and adjusting energy output when capturing fails. The potential risks and complications of long-term pacing, as well as the lifespan of temporary wires, are also highlighted.
Troubleshooting Temporary Pacing and Alternative Solutions
The episode explains the troubleshooting process for temporary pacing when capturing and sensing issues arise. Adjusting the energy output and ensuring proper wire connections are recommended to address capturing issues. Sensing issues are discussed in terms of sensitivity settings, with lower numbers indicating increased sensitivity. The possibility of over-sensing and under-sensing is explained, along with the potential risks and benefits of each. In cases where troubleshooting is not effective, alternative solutions such as medications to increase heart rate or transcutaneous pacing are suggested. The use of Zoll pads and the possibility of involving surgeons for the placement of a permanent pacemaker are also mentioned.
Considerations for Long-term Pacing and Wire Lifespan
The considerations for long-term pacing in pediatric patients are discussed, emphasizing the need to assess the recovery of conduction within a certain timeframe. Factors such as patient dependence on pacing, wire functionality, and surgical input play a role in determining the timing of permanent pacemaker implantation. The lifespan of temporary wires is explored, noting the variability in wire durability and potential factors that may increase the risk of wire fractures. The importance of adequate monitoring, sedation, and other interventions such as CPR in critical situations is also emphasized.
Closing Remarks and Resources
The episode concludes with closing remarks on the Pediatric and Congenital EP Society (PACES) and Heart University as valuable resources for further education in pediatric electrophysiology. The importance of seeking guidance and asking questions from pediatric electrophysiologists is encouraged, as they are usually happy to provide explanations and assistance in understanding pacemaker functioning and troubleshooting.
Dr. Eric Silver is an Associate Professor of pediatrics at Columbia University Medical Center. He completed his cardiology fellowship at Columbia University College of Physicians and Surgeons and his electrophysiology fellowship at Stanford’s Lucile Packard Children’s Hospital. He is a certified specialist in pediatric electrophysiology and his research has focused on invasive management of AV nodal reentrant tachycardia in children, the response of the transplanted heart to adenosine therapy, and placement of pacemakers and ICDs with minimal fluoroscopy utilizing 3-dimensional mapping systems.
Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University’s critical care fellowship program next year. He is interested in pursuing a career in cardiac intensive care.
Learning Objectives:
By the end of this podcast, listeners should be able to:
Recognize common indications for temporary pacing in the CICU
Understand the nomenclature used to describe temporary epicardial pacemakers and different pacing modalities
Recall the function of each pacing mode and which clinical settings in which it is used
Recognize the surgical and pre surgical factors that lead to higher risk of arrhythmias
Recognize and troubleshoot temporary pacemaker dysfunction
Develop a mental framework for managing those who require prolonged pacing
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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