ABSTRACT
If intrinsic atrial and/or ventricular electrical activity is present, the pacemaker will stay in ‘sense’ mode. 3 The patient had episodes of collapse due to complete heart block. As the individual was very active and the ECG showed P waves, a dual chamber pacemaker was implanted. This restores the electrical connection between atrium and ventricle, ensuring that atrial and ventricular stimuli are coordinated, avoiding ‘pacemaker syncope’– atrial contraction against an atrioventricular valve closed by ventricular contraction. Dual chamber pacing mimics the normal physiological action of the heart. 4 Pacemaker function needs checking a few weeks after implantation and at regular intervals thereafter. ‘End of battery life’ can be predicted to within a few weeks and unit replacement planned. If the patient needs surgery, both surgeon and anaesthetist need to be informed that a pacemaker has been implanted. The pacemaker should be checked before and after surgery. Diathermy can generate a high-energy field affecting pacemaker function – when it is used, it should be bipolar, with the ‘active’ electrode placed at least 15 cm from the pacemaker and the ‘indifferent’ electrode as remote as possible.
