Clinical Follow-Up
Peter Nalos, MD, FACC and FACP
The patient will be followed in the pacemaker clinic at periodic intervals to
assess all of the functions of the pacemaker. Pacemakers are tested for the
voltage and pulse width duration, which is necessary to capture the electrical
heartbeat, and this can be programmed so that the pacemaker battery will last
longer if a lower voltage is needed and may save several years of battery life.
Lead impedances are measured to be sure that the leads are functioning
appropriately and the battery voltage and magnet rate is attained to make sure
that the battery energy is good, and when this starts to fall off to a low
level, then the patient would be admitted again for another permanent pacemaker
generator. At the time of pacemaker replacement, the entire pacemaker is
removed after being disconnected from the leads. The leads are tested, and if
they are good, a new pacemaker is connected. Although people say that the
procedure is called a battery change, indeed we always change the entire
pacemaker to allow new circuitry to be available to that patient. There are a
number of new features in permanent pacemakers that have made them electronic
miracles for patients. The most important feature that is felt over the last 10
years in permanent pacemakers is that they will speed up with certain sensors
that detect body rate or breathing rate. This all can be programmed so that a
patient may go from 60 to 120 beats/minute or higher rates or even lower
resting rates if necessary, and we can program how fast we want the patient to
respond and how fast we want the rate to come back down. New pacemakers can
detect patients who have problems with intermittent atrial fibrillation, and
rather than allowing the heartbeat to beat quite rapid when this event occurs,
the pacemaker will switch to a different mode and pace the lower chamber only.
This mode switching is very useful for patients with problems with intermittent
fibrillation who may be on certain forms of drug therapy. Rate historesis is a
new pacemaker algorithm which will be appropriate for patients who have sudden
episodes of heart rate drop and faint. At this point, the pacemaker can be
programmed to detect these rapid rate drops and then kick in with a fast rate,
i.e., 90-110 beats/minute for a period of several minutes and then gradually
come down to the pacing rate to support the patient and prevent them from
fainting.
Peter Nalos, MD, FACC and FACP
- is Board Certified in Internal Medicine, Subspecialty Board of
Cardiolovascular Diseases. Doctor Nalos is a Fellow of the American College of
Cardiology. Dr. Nalos is certified by and a member of NASPE (North American
Society of Physician Electrophysiologists).
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Tetsuo Ishimori, MD
