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Antibradycardia Pacemakers

Course #90804 - $90 -

15
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
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Overview

The clinical management of the individual requiring pacemaker therapy occurs across a range of settings. Frequently, the patient's need for a pacemaker is identified when the patient presents to a physician's office, ambulatory care setting, or emergency department with a complaint of frequent dizziness, syncopal or near-syncopal episodes, unexplained falls, or increasing signs of heart failure. Implantation of the pacemaker occurs in an acute care setting, where the patient's clinical status and pacemaker function are closely monitored for a short period. Long-term follow-up generally occurs in physicians' offices or ambulatory care settings. Using the recommendations published by the American College of Cardiology Foundation and the American Heart Association, medical indications will be outlined. Preoperative, immediate postoperative, and long-term follow-up care for patients undergoing permanent pacemaker implantation will be discussed. Emphasis will be placed on patient education. Topics that will be covered include safe use of home appliances and the issues of electromagnetic interference from sources such as airport security, commercial antitheft devices, cellular phones, and others. The use of biventricular pacemakers/cardiac resynchronization therapy (CRT) for persons with severe heart failure will be explored. Finally, application of the content will be provided through detailed case studies.

Education Category: Medical / Surgical
Release Date: 09/01/2023
Expiration Date: 08/31/2026

Table of Contents

  1. INTRODUCTION
  2. PACEMAKER FUNCTION
  3. PACEMAKER CODING
  4. TYPES OF ANTIBRADYCARDIA PACEMAKERS
  5. ANTIBRADYCARDIA PACING
  6. DIAGNOSIS AND EVALUATION FOR ANTIBRADYCARDIA PACEMAKER IMPLANTATION
  7. PACEMAKER IMPLANTATION
  8. MONITORING PACEMAKER FUNCTION
  9. DISCHARGE EDUCATION
  10. FOLLOW-UP CARE AFTER ANTIBRADYCARDIA PACEMAKER IMPLANTATION
  11. TROUBLESHOOTING ANTIBRADYCARDIA PACEMAKER FUNCTION
  12. PACEMAKER SYNDROME
  13. BIVENTRICULAR PACING
  14. EMERGING TRENDS IN PACEMAKER THERAPY
  15. CLINICAL CASE STUDIES
  16. CONCLUSION
  17. RESOURCES
  18. GLOSSARY OF TERMS
  19. Works Cited
  20. Evidence-Based Practice Recommendations Citations

Audience

This course is designed for physicians, nurse practitioners, and nurses practicing in acute or adult healthcare settings.

Accreditations & Approvals

In support of improving patient care, TRC Healthcare/NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NetCE is approved by the California Nursing Home Administrator Program as a provider of continuing education. Provider number 1622. NetCE is approved to offer continuing education through the Florida Board of Nursing Home Administrators, Provider #50-2405. NetCE is accredited by the International Accreditors for Continuing Education and Training (IACET). NetCE complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, NetCE is authorized to issue the IACET CEU.

Designations of Credit

This activity was planned by and for the healthcare team, and learners will receive 15 Interprofessional Continuing Education (IPCE) credit(s) for learning and change. NetCE designates this enduring material for a maximum of 15 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NetCE designates this continuing education activity for 15 ANCC contact hour(s). NetCE designates this continuing education activity for 18 hours for Alabama nurses. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 15 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Completion of this course constitutes permission to share the completion data with ACCME. Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME and/or Self-Assessment requirements of the American Board of Surgery's Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit. Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME's "CME in Support of MOC" program in Section 3 of the Royal College's MOC Program. This home study course is approved by the Florida Board of Nursing Home Administrators for 15 credit hour(s). This course is approved by the California Nursing Home Administrator Program for 10 hour(s) of continuing education credit - NHAP#1622010‐8953/P. California NHAs may only obtain a maximum of 10 hours per course. AACN Synergy CERP Category A. NetCE is authorized by IACET to offer 1.5 CEU(s) for this program.

Individual State Nursing Approvals

In addition to states that accept ANCC, NetCE is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353, (valid through July 29,2025); Alabama, Provider #ABNP0353, (valid through July 29, 2025); Arkansas, Provider #50-2405; California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10842; District of Columbia, Provider #50-2405; Florida, Provider #50-2405; Georgia, Provider #50-2405; Kentucky, Provider #7-0054 through 12/31/2025; South Carolina, Provider #50-2405; South Carolina, Provider #50-2405. West Virginia RN and APRN, Provider #50-2405.

Special Approvals

This activity is designed to comply with the requirements of California Assembly Bill 1195, Cultural and Linguistic Competency.

Course Objective

Pacemakers are being used with increasing frequency in the United States, and healthcare professionals are likely to encounter patients for whom pacemakers may be indicated. The purpose of this course is to provide basic information on pacemaker therapy, indications for implantation, preprocedure and postprocedure care, identification and management of pacemaker malfunctions, and patient education.

Learning Objectives

Upon completion of this course, you should be able to:

  1. Describe the incidence, history, and trends in permanent pacemaker therapy for adults.
  2. Review normal cardiac conduction.
  3. Describe the basic components of an antibradycardia pacemaker system.
  4. Outline the basic and advanced pacemaker functions.
  5. Discuss five-digit pacemaker coding systems.
  6. Discuss the features of single and dual chamber atrial and ventricular demand pacemakers.
  7. Review symptomatic bradycardia and sinus node dysfunction indications for permanent pacemaker implantation in adults.
  8. Discuss second- and third-degree atrioventricular (AV) block as indications for permanent pacemaker implantation.
  9. Identify other potential indications for permanent pacemaker implantation.
  10. Describe key aspects of patient history that should be included in the diagnosis and evaluation of a patient for permanent pacemaker implantation.
  11. Discuss diagnostic tests used in the evaluation of a patient for permanent pacemaker implantation.
  12. List factors that should be considered in the selection of a specific type of pacemaker for an individual patient.
  13. Briefly describe the preprocedure care and implantation procedure for permanent pacemakers.
  14. Identify key points involved in monitoring pacemaker function in the postimplantation period.
  15. List key components of discharge education and follow-up care for a patient following permanent pacemaker insertion.
  16. Discuss identification and management of common pacemaker problems including end-of-battery life indications, failure to sense, failure to fire, and failure to capture.
  17. Review pacemaker syndrome, including signs and symptoms, underlying cause, and management.
  18. Describe the management of patients requiring biventricular pacemakers for cardiac resynchronization therapy (CRT), including indications for use and patient monitoring.

Faculty

Karen Majorowicz, RN, is currently employed in the Cardiac Intermediate Care Unit at Shands Healthcare at the University of Florida, Gainesville. She received her Master's in Medical-Surgical Nursing in 1978 from the University of Maryland. Karen has created numerous instructional manuals on Medicare and has conducted educational programs on cardiovascular assessment.

Faculty Disclosure

Contributing faculty, Karen Majorowicz, RN, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planners

Ronald Runciman, MD

Mary Franks, MSN, APRN, FNP-C

Division Planners Disclosure

The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Director of Development and Academic Affairs

Sarah Campbell

Director Disclosure Statement

The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Technical Requirements

Supported browsers for Windows include Microsoft Internet Explorer 9.0 and up, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Supported browsers for Macintosh include Safari, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Other operating systems and browsers that include complete implementations of ECMAScript edition 3 and CSS 2.0 may work, but are not supported. Supported browsers must utilize the TLS encryption protocol v1.1 or v1.2 in order to connect to pages that require a secured HTTPS connection. TLS v1.0 is not supported.

Implicit Bias in Health Care

The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.

Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.