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ClearRounds Health · Cardiology · Quick Reference
Pacemakers
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Arrhythmias & DevicesBeginnerIn progressOne-page PDF
PPM basics, indications, device checks, common symptoms, post-implant restrictions, troubleshooting, and when to call EP.
Last reviewed
Pending initial clinical review
Sources / guidelines to verify
- 2018 ACC/AHA/HRS Bradycardia & Conduction Delay Guideline
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- Implanted device for bradyarrhythmias (sinus node dysfunction, AV block).
- Leads pace the atrium and/or ventricle; common mode is DDD.
2
Key diagnostic clues
- Indications: symptomatic SND, high-grade/complete AV block, Mobitz II, selected conduction disease.
3
Initial workup
- Confirm a pacing indication; pre-implant assessment.
- Post-implant CXR (lead position, exclude pneumothorax).
4
Management framework
- NBG codes (DDD = dual sense/pace/track); device interrogation (battery, thresholds, lead integrity).
- Remote monitoring; arm/lifting restrictions ~4–6 weeks post-implant.
5
Red flags / escalate now
- Loss of capture (lead dislodgement), pocket infection (erythema/fever), pneumothorax, or post-implant tamponade.
- Syncope despite a pacemaker → call EP.
6
Follow-up / monitoring
- In-person + remote interrogation; incision/site checks.
7
Clinic pearls
- A “normally functioning pacer” doesn’t exclude other causes of symptoms — interrogate it.
- New fever + device → think infection; MRI-conditional systems need a protocol.
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