Date of Award
Master of Science (MS)
A properly functioning cardiac conduction system is integral to a patient's physiologic well-being, as it contributes to an efficient cardiac output. There are a growing number of indications for pacemaker therapy, including atrioventricular blocks, fascicular blocks, sinus node dysfunction, prevention and treatment of tachyarrhythmias, syncope, heart failure, and dilated cardiomyopathy (Gregoratos et al., 2005). Technology in these devices has evolved from simple single-chamber, fixed-rate pacemakers to more complex multichamber, rate-responsive units that have pacing, cardioversion, and defibrillation capabilities (Gregoratos et al., 2005). Indications for cardiac pacing are set to expand even further as technology continues to advance (Salukhe, Dob & Sutton, 2004).
It is estimated that more than 325,000 pacemakers are implanted in the United States each year (Mattingly, 2005). The majority of the 1 million paced individuals in the United States are over the age of 65, currently the most rapidly growing segment of the population (Dawes, Mahabir, Hillier, Cassidy, Haas & Gillis, 2006). The aging population, improvements in implantable devices, and new indications for implantable cardiac devices will lead to an escalating number of patients in the new millennium with these devices (Miller, 2005). This will inevitably result in nurse anesthetists encountering more patients with cardiac devices in practice (Salukhe et al., 2004).
Since the invention of pacemakers, technology has made them more resistant to electromagnetic interference (EMI); however, in the surgical setting several problems still occur. Although the complications are fairly low, they are serious and often life threatening when they do occur (Madigan, Choudlrri, Chen, Spotnitz, Oz & Edwards, 1999). Adverse outcomes
associated with an implantable cardiac device include damage to the device, failure of the device to pace or shock, bums to the cardiac tissue, inappropriate reprogramming, asynchronous pacing, or inappropriate antitachy cardia pacing (Zaidan et al., 2005). Several adverse clinical outcomes that can be seen include tachyarrhythmia, bradyarrhythmia, hypotension, myocardial infarction, or actual damage to the myocardial tissue (Zaidan et al., 2005). Electrocautery can be a significant source of EMI in the operative setting, if proper precautions are not taken to decrease the incidence (Dawes et al., 2006).
Schmidt, Cloris L., "Perioperative Considerations of a Patient with Implementable Pacemaker" (2008). Theses and Dissertations. 4599.