GE CARESCAPE - Pacemaker detection troubleshooting

ECG
￭Pace2:MinimizesthepossibilityofcountingpacemakerartifactasQRS
complexesduringasystole.
￭Pace1:DoesnotminimizethepossibilityofcountingartifactasaQRScomplex
duringasystole.Ifthemonitorresetsorisdischarged,ortheproleischanged,
andthemonitorissettoPace1,themonitorautomaticallychangestothe
Pace2setting.
NOTE
TRAMversion12orlaterandtelemetrywithApexPro
4.1orlaterwithenhancedpacemakerdetectionwill
automaticallydetectpacemakerswitheitherPace1or
Pace2.Selectingoneortheothermakesnodifferencein
thisrespect.
Pacemakerdetectiontroubleshooting
ProblemSolution
Howdoesactivatingpacemakerdetectionimpact
monitoring?
●Beatsthatwouldotherwisebeclassiedas
ventricularareinsteadclassiedasV-pacedifa
ventricularpacemakereventisdetected.
●Residualpacemakerenergythatmightotherwise
appearintheECGisremoved,andapacemaker
enhancedspikeisplacedintheECG.
●OntheECGwaveform,pacemakerdetection
isindicatedbyuniform,uprightpacemaker
enhancementspikesintheECGdata,both
displayedandgraphed.
Howcanpacemakerdetectionbeimproved?●Possibleproblemsinclude:
￭Heartratedoublecounting.
￭Inaccuratealarmsforlowheartrateorasystole.
￭Pacemakerspikesnotrecognizedbythe
software.
￭FalsePVCdetectionsandarrhythmiaalarms.
●Possiblesolutionsinclude:
￭Relearnarrhythmia.
￭Re-preparethepatientskin,replacethe
electrodes,andadjusttheelectrodeplacement.
￭Tryanalternateelectrodeplacement.
￭Trysingle-leadanalysis,ifavailable.
￭E-modules,TRAM,combinationmonitoring:
Switchtoanotherpacemakerdetectionmode.
Whyisthemonitordouble-countingtheheartrate,
alarmingforalowheartrate,ornotdetecting
pacemakerspikes?
Themonitorisnotdetectingpacemakeractivity.
Causesmayinclude:
●PDM,TRAM,combinationmonitoring:The
pacemakerdetectionprogramisturnedoff.Turnit
on,repreptheskinandrepositiontheelectrodesif
necessary.RelearnECG.
●Thepacemakersignalistooweakforthemonitor
todetect.
174CARESCAPEModularMonitors2062971-001