Predischarge Pacemaker Checks and Advice
The day after permanent pacemaker implantation (or just prior to discharge if “day-case” pacing is in operation), lead position should be checked by performing a PA and lateral chest X-ray (see Chap. 7). Pneumothorax and early lead displacement should be excluded. A 12-lead ECG should confirm satisfactory pacing in atrium, ventricle, or both depending on the type of pacemaker implanted, usually by application of the programmer head over the device to produce a “magnet ECG strip.” The pacing threshold should ideally be checked and the pacing parameters set appropriately by the clinical physiologist to ensure satisfactory pacing and sensing, if necessary by adjusting the pulse width (0.1–1.0 ms), output (2.5–7.5 V), and sensitivity (0.25–8 mV) settings (Figs. 8.1, 8.2, and 8.3). The pacemaker’s upper (100–180 bpm) and lower rate (30–100 bpm) limit, pacing mode (e.g., AAI, VVI, VVI, DDD), rate response, polarity (uni- or bipolar), refractory period (200–500 ms), and AVD delay (0–300 ms), etc., should also be confirmed by the clinical physiologist using the programmer and the settings documented in the case notes. For day cases, these checks will be made by the technician before the patient leaves the pacing theater.