how to assess mechanical capture of pacemaker

Capture threshold This is the minimum pacemaker output required to stimulate an action potential in the myocardium. The pacemaker is sensing Lead II, and has correctly marked the patients own or native beats (top arrows). check power, battery and connections. Results in decreased or absent pacemaker function. Ventricular pacing can cause a lack of atrioventricular synchrony, leading to decreased left ventricular filling and subsequent decreased cardiac output. Atrial (first arrow) and ventricular (second arrow) pacing spikes are clearly visible. He is interested in pacemakers (surprise), medical education and all things simulation. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Too fast = Normal response to intrinsic tachycardia, pacemaker-mediated tachycardia, sensor-induced tachycardia, atrial arrhythmias Any time you are concerned for your patient with a malfunctioning pacemaker, it is reasonable to get your cardiology colleagues involved early. PMT can occur only when the pacemaker is programmed to an atrial synchronized pacing mode (e.g., DDD). Then set the pacemaker rate. May result in rate related ischaemia in the presences of IHD. For instance, P or T waves or skeletal muscle activity may be misinterpreted as QRS complexes resulting in the inhibition of pacemaker function. 1,4 A poor threshold may be present from the time of implantation. The Cardiologist may evacuate the hematoma if it continues to expand and threatens to compromise the incision site. The paced ventricular complex results in further retrograde conduction with retrograde p wave generation thus forming a continuous cycle. This indicates that the failure to pace the myocardium in a patient with bradycardia is due to oversensing. 8. Dont forget your PAILS! Multiple causes including electrode displacement, wire fracture, electrolyte disturbance, MI or exit block. Examine the current ECG and determine the electrical axis of the pacemaker spike, the electrical axis of the QRS complex, and the morphology of the QRS complex. Transcutaneous pacemakers often show artifact after the spike. Allergic reactions to the metal components of the pacemaker have been noted in the past. mollymauk tealeaf tattoos; how far does a secondary wave travel in 10 minutes; flights from pakistan to usa cancelled A retrospective study in 2010 looked at 57 patients who were ventricular paced and diagnosed with a MI. The pacing stimulus can be picked up by the ECG electrodes and cause a deflection that may look like a QRS complex. The cause is a malfunction in the pacemaker pulse generator, unlike PMT, which is caused by an external re-entrant loop.10,11,13 Runaway pacemaker can be differentiated from PMT by the response to the application of a magnet. The lower the sensitivity setting, the more readily it will detect a subtle signal. Reduced sizes of implantable cardiac pacemakers and clinical advances have led to a higher feasibility of using such devices in younger patients including children. Paced, Fusion, and Capture Beats. Mechanical capture will cause palpable peripheral pulses and usually a noticeable improvement in patient condition. Current pacemaker generators and leads are coated with a substance to prevent the body from being exposed to the metal. A reed switch in the pacemaker generator can be used to inactivate its sensing mechanism and cause it to perform in an asynchronous mode. Bipolar spikes tend to be smaller, and examination of various leads of the ECG tracing may clarify the presence or absence of capture. Theoretically, a pacing spike occurring on the T wave could induce ventricular arrhythmias, but this is rarely a practical problem. Diaphragmatic stimulation can also occur without perforation of the right ventricular wall. This is extremely uncommon with current systems, as they have safety mechanisms to prevent lead dislodgement. Please review before submitting. These inappropriate signals may be large P or T waves, skeletal muscle activity or lead contact problems. This recording will disclose whether the patient is presently being paced and in what manner (e.g., ventricular or atrioventricular pacing). The third letter designates how the pacemaker responds to sensed intrinsic electrical activity. It is important for the Emergency Physician to understand the workings of a pacemaker, the problems that may be encountered, the etiologies of the problems, and the assessment of a patient with a pacemaker. 4. Pacing spikes within QRS may mimick undersensing, well that is not quite right. PMT will usually stop temporarily by inducing asynchronous pacing with a magnet. The normal cardiac pacemaker is the sinoatrial node, a group of cells in the right atrium near the entrance of . Normal response to intrinsic fast heart rate, If a lead is in the right ventricle (RV), it produces a left bundle branch block (LBBB) pattern on ECG, as the paced beat depolarizes across the myocardium. Interset Research and Solution; how to assess mechanical capture of pacemaker Associated decrease in systolic blood pressure > 20 mmHg during change from native rhythm to paced rhythm. Home; Products; About Us. The most common insertion site for the pacemaker wires is through the subclavian vein using a blind insertion technique. It is not an exhaustive list. Privacy Policy Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. When it malfunctions, the issue is with rate, pacing, capturing (i.e. The pacemaker is over-sensing the rhythm. how to assess mechanical capture of pacemaker how to assess mechanical capture of pacemaker Do Not Sell My Personal Information, If you need further help setting your homepage, check your browsers Help menu, Pacing Artifact May Masquerade as Capture, Transcutaneous Pacemaker: Failure to Capture and False QRS Artifact, Transcutaneous Pacing (TCP): The Problem of False Capture, Open the tools menu in your browser. Pacemaker Essentials: What we need to know in the ED, When Guidelines Conflict: Managing Atrial Fibrillation in the ED, Pacemaker Essentials: Complications You Must Know, Great Evidence in Medical education Summary (GEMeS), 1. R on T can cause ventricular tachycardia or Torsade de Pointes which we usually like to avoid. Electrical Testing Of Pacemaker 1. The majority of permanent pacemakers seen in the ED will have leads in the RV and have a LBBB pattern. A Cardiologist should be consulted on every patient who presents with an actual or a potential pacemaker problem. Ensayos PSU Online Enter https://www.ems1.com/ and click OK. A Cardiologist should always be consulted regarding a patient with an actual or a potential pacemaker problem. One or more of your email addresses are invalid. Fortunately, these events are extremely rare. This may be called Tools or use an icon like the cog. This indicates that the atria or ventricle have been captured and depolarization has occurred. Schematic of an electrocardiographic monitor strip demonstrating pacemaker-mediated tachycardia. If not, the underlying rhythm and PR interval of an intrinsic cardiac beat can be readily established (Figure 34-1A). Diagnosis of pacemaker malfunction on the ECG is very difficult and may be impossible depending on the underlying native rhythm. Complications Patients may present due to symptoms referable to pacemaker malfunction or symptoms unrelated to the pacemaker, and its presence may modify the investigation and therapeutic approach. The failure of pacemaker output is detected by the lack of pacing activity (i.e., pacer spikes) on the ECG in a patient with a heart rate lower than the programmed rate. A normal cycle with electrical capture will begin with a spike, which is a mark placed by the device software to show when the pacemaker fired. By submitting your information, you agree to be contacted by the selected vendor(s) Hayes DL, Vlietstra RE: Pacemaker malfunction. We also use third-party cookies that help us analyze and understand how you use this website. Severe metabolic abnormalities and drugs can increase the pacing threshold. He could. All rights reserved. Based on a work athttps://litfl.com. The ECG shows neither pacer spikes or pacer-induced QRS complexes, but rather the native rhythm of the patient. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. A look at the cardiac monitor shows a very slow sinus bradycardia without ST elevation or depression. NB. This protruding wire has the potential to puncture the right atrium or superior vena cava and cause a hemorrhagic pericardial effusion that may result in cardiac tamponade. Perform a magnet examination of the pacemaker. A 12-lead electrocardiogram of a dual-chamber or atrioventricular sequential pacemaker. When they arrive at the hospital, the patient is still pale and diaphoretic and her BP is 90/50. Since the pacemaker wire is usually implanted in the right ventricle, a typical paced QRS complex will have a left bundle branch pattern (Figures 34-1, 34-2, 34-3, and 34-4). 2.1.1. Ensure that the distal end of the pacing wire is within the cardiac silhouette and against the myocardium. how to assess mechanical capture of pacemaker Saturday/Sunday CLOSED. They found the discordant STE > 5mm to be the most useful criteria (specificity 99%, sensitivity 10%). Develop awareness of the revised NASPE/BPEG Generic (NGB) Pacemaker Code. The pacemaker generator battery may fail and present with too low a voltage to capture the heart but enough voltage to generate a pacemaker spike. Pacing failure:This ECG shows a ventricular paced rhythm with intermittent failure to capture: There is a rapid ventricular-paced rhythm (120 bpm) with no evidence of preceding atrial activity (except for the first complex). Okay, yes, this is part of our standard approach. Decreasing the pulse width and/or voltage output can minimize the stimulation until the defective component can be replaced. padding-bottom: 0px; LBBBs can make detecting ischemia tricky. Become familiar with the "four faces" of DDD pacing. It is mandatory to procure user consent prior to running these cookies on your website. Please consult the latest official manual style if you have any questions regarding the format accuracy. Infection may present as localized erythema and tenderness, localized inflammation, purulent discharge from the skin incision, skin erosion, sepsis, and/or bacteremia. A myocardial infarction involving the myocardium at the tip of the pacer leads will cause a rise in the pacing threshold. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. A pneumothorax and/or hemothorax may be detected in patients whose pacemakers have been recently implanted. Future areas of exploration might include the approach to identifying ischemia on the ECG if the patient is paced, common issues related to pacemakers and how to address common issues in the ED. Maloy K, Bhat R, Davis J, Reed K, Morrissey R. Sgarbossa Criteria are Highly Specific for Acute Myocardial Infarction with Pacemakers. The most common cause for a marked drop in the paced rate is battery depletion. Electrical capture. In cases of malfunction in an unstable or potentially-unstable patient, you can always try a magnet which should result in asynchronous pacing or use transcutaneous pacing until a transvenous wire is placed, depending on the issue. If you see a paced spike then you should see a P or QRS immediately following. For example, a patient who has a pacemaker with a currently-appropriate native rhythm may have an ECG that looks like the one above. Otherwise it is hidden from view. It is important to note that this diagnostic dilemma will often still require the help of our cardiology colleagues. Still, it can help us develop a differential diagnosis when we are dealing with potential pacemaker malfunction. min-height: 0px; The interrogator, in consultation with the patient's Cardiologist, may have the capability of changing the threshold setting on the device to resolve certain problems and negating the need for admission.10. However, its incidence has decreased because of recent advances in steroid-eluting leads.10,11. how to assess mechanical capture of pacemaker bunker branding jobs oak orchard fishing report 2021 June 29, 2022 superior rentals marshalltown iowa 0 shady haven rv park payson, az If the PVC is conveyed in a retrograde fashion through the AV node, it may be sensed as a retrograde P wave. . After insertion, the unit is programmed and tested. A block in the heart's electrical conduction system or a malfunction of the heart's natural pacemaker (the SA node) can cause a heart dysrhythmia. After advancing the wire about 15 cm, set the pacemaker to "asynchronous" mode, set the rate at 80, and put the output at max (20 mA). Schematic of an electrocardiographic monitor strip of an AV sequential pacemaker demonstrating lack of capture or intermittent capture. the pacemaker or pulse generator) and a lead or leads. In addressing the treatment modalities for cardiac rhythm disturbances, the decision to implant a pacemaker can be difficult and must be reached by a careful review of each patient on an individual basis. failure to pace occurs when the pacemaker fails to initiate an electrical stimulus when it should fire, is noted by absence of pacer spikes on the rhythm strip . This is usually unsuccessful, can introduce an infection, may damage the pacemaker or leads, and does not address the etiology of the bleeding. There will be no T wave following the QRS. In cardiology, a specialized cell or group of cells that automatically generates impulses that spread to other regions of the heart. Analytical cookies are used to understand how visitors interact with the website. los angeles temptation roster 2019 Watching the pulse oximetry graph is a slick way to guide pacemaker insertion. Gregoratos G, Cheitlin MD, Conill A, et al: ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). 1734 Oak Tree Road Edison, NJ. Stimulation of the diaphragm may be caused by perforation of the right ventricular wall by the pacing wire and can occur with very few complications. These must be compared to the same features on previously obtained ECGs. Electrical capture will result in a QRS complex with a T wave after each pacer spike. Tiny Tips: STEMI? In case of sale of your personal information, you may opt out by using the link. Observe the vital signs for bradycardia, fever, hypertension, hypotension, or tachycardia. The problem of false capture (also known as echo distortion) is under-recognized and under-reported in the medical literature. Look for a box or option labeled Home Page (Internet Explorer, Firefox, Safari) or On Startup (Chrome). border: none; Review the indications for permanent pacing. 9. Most pacemaker malfunctions will require a cardiology consult for definitive management, but there are some exceptions. Paroxysms of rapid pacing spikes at 2000bpm with decreasing amplitude and rate this fails to excite the ventricles due to the low amplitude spikes. Failure to sense is a result of the inability of the pacemaker to sense the native cardiac activity. If a patient's bradycardia is corrected, tape the magnet in place over the pacemaker generator. Share, teach, and receive feedback. This can cause a partial or complete disconnection of the pacemaker wires from the generator. merrick okamoto net worth #mc-embedded-subscribe-form .mc_fieldset { Can result in diaphragmatic or brachial plexus pacing (e.g. The pacemaker does not sense the preceding QRS complex appropriately and fires. She has consulting experience as a legal nurse consultant and book reviewer. Ti Ph Printing l n v hng u v dch v cung cp my in vn phng, mc my in. The ventricular rate cannot exceed the pacemakers upper rate limit (usually 160-180 bpm). But youre still pretty happy since:You 1, pacemaker 0. Copyright 2023 This indicates that the failure to pace the myocardium in a patient with bradycardia is due to oversensing. Patients with an undersensing pacemaker might present with weakness, lightheadedness and syncope due to alterations in rhythm due to competition with the native cardiac rhythm. 1-8 However, a detailed discussion regarding the indications for permanent pacemaker insertion is beyond the scope of this chapter. Twitter: @rob_buttner. This artifact can be mistaken for a QRS complex. Learn how your comment data is processed. Thrombosis of the vein (e.g., subclavian or cephalic) containing the pacemaker lead occurs commonly, but rarely causes clinical symptoms. Both electrical and mechanical capture must occur to benefit the patient. The incorrect diagnosis of a failure to pace and a lack of pacemaker output can be made if the patient's pacemaker spike is very small. (2005). Remember to evaluate the complex to determine if it is a QRS-T or just a wide artifact. . This can also be seen with current leakage from the connector of the pacing wires or sealing plugs. Transcutaneous pacing (TCP) is a difficult skill that is often performed incorrectly. Reduced pacemaker output / output failure may be seen on ECG monitoring if the patient stimulates their rectus or pectoral muscles (due to oversensing of muscle activity). The second letter designates which cardiac chamber(s) the pacemaker uses to sense intrinsic electrical cardiac activity. If the generator is pacing intermittently, the magnet may not be directly over the pacemaker generator. Output failure occurs when a paced stimulus is not generated in a situation where expected. Recipients may need to check their spam filters or confirm that the address is safe. Lexipol. If, on the other hand, the lead is in the LV, it will produce a right bundle branch block (RBBB) pattern. 1. Several types of pacemaker associated dysrhythmias can occur including pacemaker-mediated tachycardia (PMT), sensor-induced tachycardia, runaway pacemaker, pacemaker-mediated Wenckebach AV block and lead dislodgement dysrhythmia. The crew starts an IV and attaches pacemaker electrodes. I have to say other content as well such as runaway PPMs dont really occur unless the device has been significantly damaged by say radiation of high frequency and 2000 bpm Come on I think at times youre trying to scare people reading this, I worry that physiologists everywhere will get inundated with queries as people will be reading this on your site. Strayer Transvenous Pacemaker Instruction Sheet . The general range of sensitivity for a normal pacemaker box is 0.4-10mV for the atria, and 0.8-20mV for the ventricles. This is failure to pace (FTP). 10. The device interrogation by the industry representative or a cardiology technician is a vital part of the Emergency Department evaluation of a patient presenting with symptoms that might be attributed to the pacemaker. A chronic rise in threshold can be related to fibrosis around the tip of the lead, causing lack of capture or intermittent capture. A pacemaker consists of a box (i.e. Example: jdoe@example.com. It can also be used in an attempt to terminate pacemaker-mediated tachycardia (PMT, discussed further on in this chapter). The 4 steps are summarized nicely into an algorithm in the above infographic. long island high school colors and mascots. The pacemaker unit is implanted by a Cardiologist in the cardiac catheterization laboratory. Patient manipulation of the pulse generator (accidentally or deliberately). This is failure to sense (FTS or under-sensing). First documented as a technique in 1872, transcutaneous cardiac pacing (TCP) was successfully demonstrated in two patients with underlying cardiac disease and symptomatic bradycardia by Paul Zoll in 1952. This isnt really an issue anymore due to effective blanking periods namely PAVB in this case preventing cross talk as the V is functionally blanked during this period. View our Terms of Service To obtain the magnet rate, place a standard magnet over the pacemaker generator while simultaneously obtaining a 12-lead ECG and rhythm strip. Schematic of an electrocardiographic monitor strip of a dual-chamber pacemaker. Join our community of educators by submitting a blog post, opinion piece, chalk talk, or lecture. font-weight: normal; It is important to go through a consistent approach when interpreting pacemaker ECGs, ideally the same one you use for non-paced ECGs. Occasionally, the pacing wire will be implanted in the left ventricle and the QRS complex will have a right bundle branch pattern. to perform CPR) during pacing. The pacemaker lead may have become dislodged from its implantation site. The purpose of the following steps is to provide the emergency physician with a simple way to approach pacemaker malfunction. no electrical output at the pacing wire tips (pacing spikes absent on ECG) causes: lead malfunction, unstable connection, insufficient power, cross-talk inhibition, oversensing (see below), apparent failure to pace. The AVEIR VR leadless pacemaker has an active helical fixation which uses a screw-in mechanism designed for chronic retrieval 1,2*, a battery projected to last up to twice as long as current VR leadless pacemakers based on ISO standard settings 1,3** and mapping capabilities designed to help reduce the number of repositioning attempts. Evaluate the veins of the head and neck for venous engorgement suggesting a central venous thrombosis or a superior vena cava syndrome. Check for mechanical capture by taking a pulse on the femoral, brachial or radial artery. A fusion or pseudofusion beat can occur due to pacemaker firing on an intrinsically occurring P wave or QRS complex. It is responsible for the functioning of the unit and contains the battery that powers it. When pacing with a TCP, do not rely on electronic vital-signs measurements and heart-rate monitoring to determine the patients condition. Failure to capture occurs when paced stimulus does not result in myocardial depolarisation. However, to use maximal sensitivity settings . The unit may be sensing a large T wave as a QRS complex. In contrast, the higher the sensitivity setting, the less sensitive the pacemaker will be when detecting low amplitude electrical activity. If the patient is unresponsive, slow the pacemaker to look for the presence of ventricular fibrillation, which can be masked by TCP artifact. There is a long pause with no pacing spike delivered. how to assess mechanical capture of pacemaker Larne BT40 2RP. Nonsteroidal anti-inflammatory drugs, excluding aspirin, are adequate and appropriate to alleviate the discomfort. A doughnut-shaped magnet is required for this procedure. Pacemaker rhythms: Normal pacemaker function. Phibbs B, Marriott HJL: Complication of permanent transvenous pacing. If the pacemaker spikes occur at less than the programmed rate, the battery may be depleted or the set rate has been changed. Over-sensing = less pacing spikes than you need while under-sensing = more. Only 17 patients (0.1%) had a ventricular paced rhythm [3]. Caused by improper timing of atrial and ventricular contractions resulting in AV dyssynchrony and loss of atrial kick. increase output to maximum (20mA atrial and 25mA ventricular) You also have the option to opt-out of these cookies. However, in older people, this . Menu (732)548-0013/0015. We can, but its use is quite limited. If you found this useful, stay tuned for Part 3: Okay enough on Pacemakers, lets talk ICDs and CRT. . How do you assess mechanical capture of a pacemaker? A sensed event may inhibit (I), trigger (T), both inhibit and trigger (D), or cause no response (O) from the pacemaker generator. 188.165.239.102 This means it incorrectly senses things other than a P or QRS and is being tricked into thinking the native rhythm is okay (e.g. Recent pacemakers contain crucial information such as the range of heart rate, percentage of pacing, intracardiac ECG recordings as well as arrhythmia logs.9 The pacemaker can be interrogated to obtain generator life, lead integrity, false discharges, undersensing, and oversensing. Dr. Lorne Costello is an emergency physician at Sunnybrook Health Sciences Centre and Michael Garron Hospital and an assistant professor at the University of Toronto. Obtain posteroanterior and lateral chest radiographs if the patient is stable. Magnet effect. Basic Airway Assessment: Its as easy as 1-2-3? Patients may complain of anxiety, apprehension, dizziness, fatigue, pulsations in the neck, or shortness of breath. Ortega DF, Sammartino MV, Pellegrino GM, Barja LD, Albina G, Segura EV, Balado R, Laio R, Giniger AG. The T wave is usually in the opposite direction of the QRS. Unipolar pacing involves a relatively large electrical circuit. Oversensing is the inappropriate inhibition of the pacemaker due to its sensing of signals that it should otherwise ignore. Taking a systematic approach to all ECGs will ensure that you dont miss any key findings, whether or not the patient has a pacemaker. Accessibility When the patient's heart rate is improved with pacing, give the patient a few minutes to improve hemodynamically before deciding to give large amounts of fluid. A hematoma can be managed with the application of dry, warm compresses to the area and oral analgesics. Figure 51-1 Permanent pacemaker pulse generator. This is called a discordant T wave, and it is normal in wide-complex rhythms. The monitor will blink, or stop showing information, for approximately 40-80 ms (1-2 small blocks) after the pacing stimulus is delivered. A paced beat occurs when ventricular depolarization is secondary to pacer stimulation (Figure 34-1B). If the intrinsic cardiac activity is below the programmed rate, a pacemaker spike will be seen followed by a QRS complex in a single-chamber or ventricular pacemaker (Figure 34-2). Previous chest radiographs should be obtained and compared to the current radiographs to help determine if the leads have been displaced. The patient should not be taking aspirin in the immediate postimplantation period unless authorized and/or prescribed by the Cardiologist. The initial evaluation begins with a complete history. Additionally, if there's not enough blood to fill the vessels, even effective pumping may not produce clinical benefits. Sgarbossa E, Pinski S, Gates K, Wagner G. Early electrocardiographic diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. Pacemaker-mediated tachycardia (with retrograde P waves buried in the QRS complexes /T waves). This is failure to capture (FTC). How to recognize electrical and mechanical capture. clear: left; interacts with each other and researches product purchases Pacemaker malfunction can occur for a wide variety of reasons, ranging from equipment failure to changes in underlying native rhythm. Three primary problems can occur with a pacemaker, these problems include failure to pace failure to capture, and failure to sense. Lets shift our focus to the ECG, and hopefully well discover some pearls to help us with these troublesome devices. Palpitations, dizziness, near syncope, syncope, or any symptom that may resemble those prior to pacemaker implantation may reflect a potential pacemaker malfunction. Assure the patient that the discomfort and ecchymosis will resolve spontaneously. Obtain a 12-lead ECG. Sensing is the ability of the pacemaker to detect the hearts intrinsic electrical activity. hydrangea pink avalanche 29th June 2022. The North American Society for Pacing and Electrophysiology and the British Pacing and Electrophysiology Group have accepted a five-letter pacemaker code, which is also followed by the pacemaker industry (Table 34-1). The morphology is similar to that of the intrinsic QRS complex (Figure 34-1D). Placing a magnet on the pulse generator will affect its functions. Results in a paced tachycardia with the maximum rate limited by the pacemaker programming. width: auto; Now, here are 4 steps that you can add to your regular approach whenever you see a paced ECG. However, the pacemaker spike is very small on the ECG, so if the cardiac monitor you're using has a "paced" mode, select it so you can more easily see the pacemaker spike (see Figure 4). Could potentially be normal in the presence of an appropriate physiological stimulus (e.g. Patients generally do not require prophylactic antibiotics when they undergo a procedure that is likely to produce transient bacteremia. Pulse generator output circuit Site At implantation Acute Chronic Atrium <1.5mv 3-5 times Twice the threshold Threshold voltage voltage Ventricle <1mv With PW 0.5ms With PW of 0.5ms. Her BP is 72/44. Determine if the patient is taking medications that can raise the myocardial threshold to pacing. Epstein AE, DiMarco JP, Ellenbogen KA, et al: ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. the untamed album cover. Check for electrical capture by the presence of a pacing spike followed by a widened QRS complex (response to the stimuli), the loss of any underlying intrinsic rhythm, and the appearance of an extended, and sometimes enlarged T wave. Blood pressure is an important assessment relating to cardiac output and organ perfusion, but it does not determine if the client's pacemaker is capturing the mechanical activity of the heart Option 3: A 12- lead ECG does not assess mechanical capture of cardiac activity via the client's pacemaker Option 4: