Pacemakers—determining the right amount of pacing

In this video from our Pacemaker Essentials course, you'll learn why we minimize the amount that a pacemaker is intervening for both physiological and longevity reasons. Find out why treating a patient's symptoms is the primary objective and should not be compromised when minimizing pacing.

Take the mystery out of pacemakers with our Pacemaker Essentials course. Learn how pacemakers work, what can be done in order to optimize a patient’s pacemaker therapy, and how to recognize and troubleshoot common problems. By the end of this course, you’ll feel comfortable addressing the most common pacemaker issues without having a pacemaker expert on hand.

[00:00:00] So, as you know every patient is different. When we program a pacemaker, we actually have to optimize it with that patient in mind. Now, some of the optimization we look at looks to reduce the amount of pacing that the pacemaker delivers. By using programming adjustments, you can reduce the frequency that a pacemaker has to pace the heart and this is something we need to

[00:00:30] bear in mind. Now, there's two rules of thumb, one of which we've covered already. In a biventricular pacemaker, we aim for 100% pacing. So, we want to be delivering that therapeutic, synchronized RV and LV contraction 100% of the time, okay. In all other types of pacemaker, the less pacing that treats the patient symptoms, the better.

[00:01:00] And this is what we're really going to talk about in this tutorial. So, forget about biventricular pacemakers for now and we're going to focus on the other types of pacemakers where we want to reduce the amount of pacing that occurs. So, why do we want to do this? Well, less is more. One of the most obvious reasons is if the pacemaker is expending less energy, pacing the heart less frequently

[00:01:30] is going to save a lot more battery. Well, actually, there's more to it than that. If you think of the pacemaker as a medication, which it is, it like many other medications has side effects. And studies have shown that actually, too much pacing can lead to atrial fibrillation and heart failure symptoms. Again, I just want to reiterate, we're not talking about those patients that already have heart failure and a biventricular pacemaker. These

[00:02:00] are your patients that might have a healthy heart structurally but have a conduction system problem. Now, if we pace their heart too often, you can get atrial fibrillation and heart failure. Here are some graphs that show the risk of heart failure hospitalizations with relation to cumulative ventricular pacing. So, all of the graphs essentially show the same thing. The more ventricular pacing that occurred,

[00:02:30] the greater the risk of heart failure hospitalizations. So, it really is something that we have to take on board and be mindful of when using a pacemaker to treat our patient's symptoms. Having said that, it is a balancing act. Treating a patient’s symptoms comes first. This is the reason you have put the pacemaker in, in the first place. If that requires 100% pacing then

[00:03:00] unfortunately that is what it requires and we're unable to reduce the amount of pacing. But treating a patient’s symptoms is the main priority. I'm going to reiterate that once more in your takeaway message—despite wanting to minimize pacing, treating the patient's symptoms is the most important consideration.