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Help and Support
FAQ
For Heart
ICD Pacemaker Cardioverter Defibrillator Implant Recipients
Families, Doctors,
Medical School, Medtronic, Guidant, St Jude, Recalls, Atrial
Fibrillation, Arrhythmia Treatment, Cardiac Ablation, Comparison,
Phillips, Zoll aed,
Trainers, and Care Givers.
Q. How
much is the ICD going to protrude from my chest and will I look like a
freak in a bathing suit?
A. That depends on your body and the type of implant you receive. Most
of the new units are very small and appear no larger than a pill bottle
lid. It will be easier to see if you are skinny, but it will not make
you look like a freak.
Q. Will my husband/wife be afraid to touch me?
A. He or she shouldn't unless your husband/wife was afraid to touch
you before your implant. Even if someone is in contact with you when
the device zaps you, that person will not be hurt. At most, a bystander
may feel a little tingle. One reader wrote to say his spouse actually
enjoyed the feeling during an intimate moment.
Q. What's the maintenance on this device?
A. Just make sure you make your regularly scheduled interrogations -
usually once every three months. If something needs to be done, the
professionals will take care of it. Otherwise, you need to do nothing
for it - no oil changes, no air pressure checks, no adding of fluids
like antifreeze.
Q. Will an ICD change my quality of life?
A. Only if YOU let it become an excuse for not doing things you want to
do. The condition you have that requires the implant of the ICD may
have a profound impact on your life. But the device itself should be
nothing more than a small annoyance when you swing a golf club or tennis
racket and demands no attention beyond the routine interrogations.
After the surgical wound heals, you can nearly forget about it and go
about living life the way you choose.
Q. How much does an ICD cost?
A. Like a car, it depends on the model implanted. Some people need
lots of the new whistles and bells for specialized treatments such as
CHF - others are fine with the basic monitor and therapy functions.
Generally, the basic hardware costs $35,000 and the surgical costs for
doing the implant run about $35,000. Much of that is covered by most
insurance companies, including Medicare.
Q. How long does an ICD last and why does a pacemaker last longer?
A. Current models can last up to eight years. That can be reduced by
the number of times you need "therapy" and will be shorter if you need
frequent pacing. A pacemaker lasts longer because its battery demands
are much lower - its purpose is simpler requiring much less energy and
demanding less power for monitoring and analysis.
Q. I feel scared, depressed, etc. Is this normal?
A. This is very common among all - ICD recipients and their loved
ones. In fact, if you do not experience this, you are the exception.
Because it's a pretty normal reaction to needing a piece of electronic
hardware inside you to stay alive, it is imperative you find ways to
deal with it. For extreme cases, your doctor may prescribe psychotropic
drugs such as paxil or xanax.
As time passes, you may be able to stop taking drugs as you find other
ways to deal with the fear and depression. Many of us find just
"talking about it" is every bit as effective as drugs. Local ICD
support groups are great for providing this kind of outlet.
Our online, real-time support groups have given relief to people over
the years - as ICD recipients can share thoughts with others who have
experienced the same things. Our internet messaging service provides
a way to exchange thoughts with others at any time of the day or night.
Others prefer posting messages on the Forum... then come later to read
responses to their posting (or via email for the list service.)
Scientific research and personal experience have shown the emotional
impact is actually greater on our loved ones than us - the implant
recipients. Because of that, we make all of our programs available to
spouses, significant others, parents, children, and others. Be sure to
let your friends and family knows: They are welcome here, too.
Q. Can I still have a heart attack even though I have the ICD or do I
become immune?
A. Yes, you can still have a heart attack. An ICD does not prevent a
myocardial infarction, which is a blocked artery causing heart muscle
tissue to die. Things like exercise, improved diet, reduced stress, and
other lifestyle changes suggested in a cardiac rehab program will reduce
chances for a heart attack.
The ICD implant will save your life 99% of the time if you have a
potentially lethal episode of arrhythmia. (According to current
statistics.) Currently, available medications prevent fatal arrhythmias
about 85% of the time. So you can see, the ICD does increase your
survival odds significantly.
Since arrhythmia is often experienced by people after an MI, your device
may act as an early warning system - to announce you have a problem
needing prompt attention for situations such as a heart attack,
congestive heart failure, or an electrolyte imbalance - all of which can
be life threatening.
Q. I feel flutters at times. Are missing heartbeats normal?
A. Actually, most of the time it's not a "missing" heart beat... but an
extra one that we experience in the form of a PVC - pre-ventricular
contraction. While discomforting they are not uncommon and only become
a problem when there is a long sustained run of them. Many of us take
medications to decrease these events - and the ICD is inside us to take
care of those which may lead to a dangerous situation.
Suggestion: Don't stare at your EKG monitor in the ambulance, ER, or
CICU looking for these things. If they happen, they happen. Learn to
trust your device and your caregivers to respond if necessary. You
should NOT worry as that will only make the situation worse - perhaps
much worse.
Q. What does a shock (aka: "zap" by us and "therapy" by doctors) feel
like? (The #1 question asked.)
A. That’s a tough one. Like a sneeze, everyone’s reaction is
different. Some people describe it like being kicked by a mule, others
hit by a two by four; still others describe the rush of electricity
through their body to ground. Some people black out and may collapse
before “therapy” is administered. Others are conscious for the whole
thing. The lucky ones feel a little tingle. Suffice it to say, it’s not
the most pleasant experience that you will encounter during your life.
However, it sure beats the alternative!
Some times a single shock is enough to restore your heart back to a
normal rhythm, other times you make be shocked multiple times. This is
often referred to as an "electrical Storm."
Q. What should I do after a shock?
A. Sit down, if you’re not already sitting or lying down! If the first
shock doesn’t correct the problem you may receive another. You want to
avoid further injury as you may fall onto something.
Your doctor should have given you instructions on how to proceed.
Generally, if you have received multiple shocks they will want to see
you immediately. If you have a single shock and you feel fine, you
should still give your EP office a call. They may set up a time in the
next couple of days to interrogate your device.
Q. Will I be able to drive? (The second most asked question.)
A. Driving restrictions vary from state to state - many prohibit
driving for a period of 3 or 6 months from the date of implant. Others
only restrict driving if you've blacked out during the last several
months. Your doctor, local DMV, or State Police should be able to
advise you about whether you may drive.
Even if you are permitted to drive you may want to consider letting
someone else drive if that is possible. This is especially true if you
faint or blackout due to your condition. Before driving you should be
comfortable with the potential consequences if you were to have a shock
while at the wheel. A recent study did conclude that Zappers were safer
drivers (involved in fewer fatalities) than the general public.
Remember: Having an ICD does not restrict your driving privilege. The
reason you have an ICD is what determines whether you can drive.
Q. Will my car's seatbelt interfere with my device?
A. A seat belt may feel uncomfortable, especially the first few weeks
after implant. Some people find that a padded seat belt protector
reduces the discomfort. (You can also just wrap the seat belt with a
towel.)
Q. I am going on a trip. What do I do about airport security? Will
the scanners interfere with my ICD?
A. Make sure that in addition to your passport or other identification
that you also have your ICD owner's card with you when you travel.
Generally, you can pass through the scanner, but you may likely set off
the alarm. NEVER let the security guard scan you with the handheld
wand; it can interfere with your device and change the programming!
Have your ICD card handy to show security. Tell them that you have an
ICD / pacemaker and you need to be hand searched. Some people are more
comfortable requesting a hand search from the start.
Airport security guards are pretty good about this, but most deputies at
court houses have yet to receive the training necessary to understand
the danger to us. If you run into a uniformed officer determined to use
the wand: Demand they call their supervisor to the scene!
Q. What about store security systems?
A. Generally, they do not interfere with your device. Walk thru them.
Do not linger between them. In those rare cases where you set off the
detector, just show them your ICD implant card and you can continue on
your way. If you hear a beeping noise - it may be your ICD telling you
to move away from the detectors.
Q. My ICD is making a beeping noise, what should I do?
A. Some ICD’s make audible tones for a variety of situations. Some are
programmed to do a “self check” every day at a specific time. If there
is a problem, broken lead, low battery, etc. it will make a noise. If
there is a more immediate problem the device may emit a constant tone.
If your device starts making a tone contact the doctor/hospital that
monitors your device. They will advise you what to do next.
In addition some ICD’s will emit a tone if you are too close to a
powerful magnetic field. This is often reported by concert fans that
stand too close to the huge loud speakers. Move back away from the
potential source. If you are clear of the field the noise will
disappear.
During your next interrogation ask and they should be able to
demonstrate the noises your ICD can make and explain their meanings.
Q. How do they change the ICD batteries?
A. Actually they cannot change the batteries. The ICD is an intact
sealed case. When the batteries run low your implant will be replaced.
This is not bad because each generation of ICD is smaller and more
sophisticated that the generation before, allowing you to get upgraded
hardware.
Generally, the replacement is done on an out-patient basis. If the
leads are still good, they will open you up, remove the old ICD, and
install the new one. Your recovery time will be faster. You will not
have the same restrictions about raising you arm and lifting as during
the initial implant.
Q. What are interrogations?
A. An interrogation is a periodic visit where the medical personnel
with connect your ICD to a computer. They place a device on the skin
above your ICD that is about the size of a computer mouse. Using the
computer they can download information about events that were detected,
therapy administered, make adjustments in the programming, test leads
and the device, and verify battery settings. More and more device makers
are offering advanced systems that allow the remote monitoring of an ICD
over phone lines, cell phones, internet connections, even satellites!
You should bring a list of medications that you are currently taking.
In addition, if you have any notes about dates/times when you didn't
feel well, you may want to bring them too.
The results of the interrogation will be printed out and added to your
file. You may want to request a copy of your device settings to keep
with you, especially if you travel.
It is not painful. You are able to talk and ask questions during the
interrogation. If they exercise some of the pacing functionality you
may experience some discomfort or facial "flushing" as the technician
increases the pace of your heartbeat.
Q. What’s pacing and why do I have it?
A. Almost all implantable Cardioverter-defibrillators have built in
circuitry to pace the heart, in addition to familiar "zapping" function
to correct V-Tach or V-Fib, when the heart beats too fast. The pacing
function starts if the heart beats too slowly. That happens to many of
us, especially when we sleep, because some of the anti-arrhythmic
medicines we take do slow down the heart beat. Newer ICD models will
actually try to pace you out of a dangerous arrhythmia, before giving
you a full powered therapy.
Q. What is a NIPS test?
A. NIPS stands for Non-Programmed Stimulation test. So clinics
periodically (every year or two - if you have not received a therapy)
perform this procedure, others never do this after you are initially
implanted. This test is done on an outpatient basis. Under anesthesia,
your heart is placed in arrhythmia, and your ICD shocks you back into
normal rhythm. If for some reason the device does not work correctly
they would restore a normal rhythm with an external defibrillator. The
purpose of the test is to verify that all the components are connected
and functioning correctly.
Q. What’s inappropriate therapy?
A. Though the programming in the ICD's is very sophisticated there are
situations where physicians may misdiagnose your situation resulting in
improper ICD programming, and you get a shock/zap/therapy that is not
needed. This is called an inappropriate therapy. Many inappropriate
therapy situations can be addressed by reprogramming in your ICD.
Others may be avoided by medication. Finally, the ICD manufacturers are
always trying to improve their devices to avoid these situations. The
vast majority of shocks received are appropriate and life saving
therapy.
If you do receive an “inappropriate therapy,” don’t be surprised if you
wish that your doctor, nurse, etc would receive a little “inappropriate
therapy” themselves. Especially, if they caused the problem by the
settings.
Q. What are phantom zaps?
A. Publisher, Jon Duffey is credited with first joining the words to
form the name "Phantom Zap," having authored the term for an article he
wrote in early 1995.
This, like the depression and anxiety is pretty common. Many Zapper
readers report being zapped (usually as they are going to sleep or
waking up) but their subsequent ICD interrogation shows nothing
happened. OK, there was no 700 volt dose of therapy. But it sure felt
like the real thing. Your doctor may tell you it was just your
imagination, but that doesn't mean it is not a real problem that needs
to be addressed. Some report relief by going to a hypnotist.
One important thing to help stop these annoying episodes is to
understand what is happening. Like the term " Phantom Zap," Duffey is
responsible for this idea. It's only a theory but thinking about it
this way has helped many accept them and gradually make them go away:
*
When your device was implanted, you were asleep.
*
After the device is implanted, doctors test the device to make
sure it works on you. (See NIPS above)
*
Even though you were unconscious, the event was burned into your
memory - but a section of memory that is not easily accessed when you
are awake.
*
However, in that brief period between being wake and going to
sleep - or during that period when you awaken from a nap or sleep -
THOSE memories are accessed.
*
In that limbo state, what you experience is every bit as real as
an actual dose of therapy.
*
Ultimately, when you accept them as a flashback of a reality from
your past (the testing after implantation) they seem to lose their
reason for being (raison d'être) and fade away.
Q. What’s an ejection fraction?
A. With each beat, a healthy heart will pump out 55% to 60% of the
blood in it. After a heart attack or other ailment that damages the
heart muscle, that number (the ejection fraction) is reduced. The
government standard for disability approval is usually anything under
30%. Heart patients, not excluded for a heart transplant for reasons of
age or other health problems, become "candidates" for transplant when
their EF drops below 19%.
Medical science is making significant progress finding ways to boost
heart patients' EF. Among those are a variety of medicines such as
coreg (carvedilol.) Others are finding relief - with an increase in EF
- from a relatively new therapy in the United States called EECP which
was developed in China. Unfortunately, not every drug or procedure
works for everyone. Each of us needs to explore the options with our
doctors.
Q. My doctor won’t talk with me or answer my questions. What should I
do?
A. Remind your doctor, that you are the patient. You've got the
condition. You deserve the right to understand your treatment and have
your questions answered. If your doctor doesn't correct that behavior
immediately, then FIRE him or her ASAP - and find someone you can
trust! A lack of confidence in your caregiver can lead to other
problems and not all of them are emotional. You (or your insurance)
pays them. They work for you. If you are not getting what you want,
need, and deserve - you are throwing money... and your health... away.
You should consider this action even if the doctor is great, but an
incompetent staff prevents you from getting the appropriate care.
When you fire a doctor, make sure your medical records are transferred
to the new physician - completely and immediately. Without those, your
new care givers will have an incomplete picture of what makes you a
unique patient.
Q. What's the difference between an EP and cardiologist?
A. Think of it this way.
1. Consider your cardiologist as your heart's plumber. His specialty
is your pipes.
2. Consider your electrophysiologist (EP) as your heart's electrician.
His specialty is your wiring.
Q. Can I still work with an ICD?
A. That all depends on your condition and your line of work. Many ICD
owners still work without a problem. For others the condition that
caused the need for the ICD is significant enough that they qualify for
social security disability. Some people need to find a different type
of work – for example you may no longer be qualified to be a front line
police officer, or a steel worker balancing on a girder hundreds of feet
above the ground, if you have the potential of getting a 700 volt zap.
Q. Can I still have sex? What will happen to my partner if I receive a
shock? (The #3 most asked question - more often than the one above if
keeping track of priorities!)
A. Many zappers can attest to having happy and fulfilling sex lives.
Sex does elevate your heart rate, similar to exercise. If you were to
receive a shock during sex, they say your partner would feel a slight
tingling and the electrical energy dissipates.
Many of us with an ICD do experience trouble in this area, but it is NOT
the implanted device causing problems - beyond the mental issues. Many
of the medications we take have a profound impact on love making
equipment. That does NOT mean you should stop taking your pills! Work
with your doctor to find alternatives and solutions to this situation.
Q. Can I still golf? Ride a bike? Run? Swim? Play football? Dance? Play
the violin?
A. You will be able to do many of the activities that you were able to
do before the implant. You should always talk with your doctor before
resuming any of these activities. Some activities like contact sports
that could damage your device or cable may be prohibited. Others like
swimming may be discouraged, or allowed with certain restrictions.
(After all what’s the advantage of saving your life, if you drown in the
process!)
Quite a few ZAP• Folks have run marathons and triathlons, climbed
mountains (such as Machu Pichu,) 100 mile bike races, or played 36
holes of golf a day for 3-4 days. While these are extremes many others
do participate in varying levels of physical activity. Mowing a lawn
can be an achievement! Your doctor may suggest that you participate in
cardiac rehab where you exercise under controlled circumstances, under
close supervision to learn the appropriate levels and types of exercise
for your situation.
Many ICD owners are also on medication to lower their heart rate. As
a result, they may find it difficult getting the heart rate elevated
into the “target zone” for exercise. Your physician may suggest that
you still exercise, but do not attempt to elevate your heart rate
significantly.
Your ICD monitors your heart rate and when it exceeds a certain
threshold it delivers a shock. If you are an active exerciser, your
doctor may have to adjust your settings to ensure that an elevated heart
rate during exercise does not result in an “inappropriate therapy?”
Q. Can I ride amusement park rides?
A. You better talk this over with your doctor. Your specific condition
may, or may not make it an unsafe adventure. The publisher has had no
problem on wild roller coasters, but did get zapped watching his college
team play basketball. Different kinds of excitement affects each of us
differently.
Those of us with an abdominal implant site may not be able to handle
rapid direction changes, which may damage the leads. Some rides also
use powerful electromagnets, and the radiation field could affect device
programming. That could be catastrophic! Park administrators can tell
you which rides pose this kind of problem.
Q. What are all those alphabetical codes/abbreviations my doctors and
nurses use?
A. There are a bunch of them. This list of cardio codes was compiled
by Eileen Yeisley, RN:
ICD/Pacemaker Abbreviations
A-A Interval: Interval between two paced atrial contractions. When there
is an atrial contraction for each ventricular beat, the A-A Interval is
the same as beats per minute or heart rate. A-A Interval is usually
measured in milliseconds (ms); one ms is 1/1000 of a second. A normal
A_A Interval is between 600 and 1000 milliseconds or 60 to 100 beats per
minute.
AICD: Automatic Implantable Cardioverter Defibrillator. AICD is a
Guidant trademark.
ADL: Activities of Daily Living. Includes activities like feeding
oneself, bathing, brushing one’s teeth, etc.
AF: Atrial Fibrillation. Although not usually a life threatening
arrhythmia, atrial fibrillation can cause a loss of ‘atrial kick’;
responsible for about 25% of cardiac output. It is a condition where the
muscle cells of the atria do not contract at the same time but each cell
at its own rate. This results in a ‘quivering’ of the atria instead of
a contraction that would push the blood into the ventricles.
AP: Atrial Pace; when a pacemaker or ICD paces the atria (stimulates it
to contract).
AS: Atrial Sense; when a pacemaker or ICD senses depolarization of the
atria when the heart depolarizes on it’s own. The muscle must depolarize
to initiate a contraction.
AV: Atrioventricular; meaning of the atrias and the ventricles.
BBB: Bundle Branch Block; a block in conduction of electrical activity
in one of the three bundle branches.
BOL: Beginning of Life; a term used to describe the battery condition of
a new pacemaker or ICD.
BPM: Beats Per Minute; the number of beats the heartbeats in one minute;
normal is between 60 and 100. Also known as your pulse (i.e. a pulse of
80 means a heart rate of 80 bpm). bpm = 60,000 divided by milliseconds
CO: Cardiac Output; the amount of blood the heart ejects in one minute.
It is the stroke volume (amount of blood ejected in a single heartbeat)
times beats per minute; usually measured in liters per minute.
CPR: Cardiopulmonary Resuscitation
EGM: Electrogram; an "EKG" measured from within the heart instead of
from patches placed over the chest. Because it is less likely to pick up
other electrical stimuli from other muscles it tends to be more
accurate.
EMI: Electromagnetic Interference; interference that can upset the
workings of pacemakers and ICD's; caused by high-energy forces; MRI's,
arc welders, transformers, can all cause interference with pacemakers/
ICD's.
EOL: End of Life; a term used to describe the battery condition of a
used up pacemaker or ICD. When and ICD or pacemaker is approaching EOL
your cardiologist will schedule surgery for a replacement.
EP: Electrophysiologist; a cardiologist who specializes in electrical
problems or arrhythmias of the heart.
EPS: Electrophysiology Study; there are two main workings of the heart:
1. the plumbing and 2. the electrical circuits. A cardiac
catheterization studies disease in the ‘plumbing of the heart’
(blockages in the arteries of the heart) and electrophysiology studies
disease in the electrical circuits of the heart).
ICD: Implantable Cardioverter Defibrillator
IPG: Implantable Pulse Generator; pacemaker.
mA: Milliampere; 1/1000 of an ampere; used to describe current flow of a
pacemaker or ICD.
ms: Millisecond; used in EP studies to measure beats per minute and the
different waveforms of electrical activity of the heart. 1/1000 of a
second. To convert beats per minute to milliseconds: ms = 60,000 divided
by bpm
NGB: Generic Pacemaker code; code used to describe pacemaker functions.
Usually 3 or four letters. DDDR is a common code for pacemakers and
ICD's. The first letter signifies the chamber paced. V means Ventricle,
A is Atrium, D is both or Dual, O is none and occasionally S is used by
some manufacturers to mean Single. The second letter indicates the
chamber that is sensed (the ICD/ pacemakers detection of electrical
activity). The third letter indicates the pacers response to sensing; T
means it will trigger pacing, I means it will inhibit pacing D means
it will do both inhibiting and triggering, and O means none. The fourth
letter is for programmability functions—Rate responsiveness. P is simple
Programmable; M is Multiprogrammable; C is Communicating functions
(telemetry); and R is Rate Responsive. If a fourth letter is present it
is usually rate responsive. Therefore, a pacemaker or ICD that is DDDR
means the pacemaker is pacing electrical activity in both the atrium and
the ventricle and it is sensing activity in both the atrium and the
ventricle. When it senses an event it will either trigger a response or
inhibit pacing and the rate is responsive (the pacing rate will change
in response to sensors that detect changes in metabolic needs to
increase the cardiac output).
NSR: Normal Sinus Rhythm. The a normal EKG waveform.
PAC: Premature Atrial Complex. If the atria conduct a beat before it
should they will not fill properly before contracting. If this occurs in
the ventricle it is called a PVC or premature ventricular contraction.
Both can lead to ventricular tachycardia although it is more common with
PVCs.
PMT: Pacemaker Mediated Tachycardia. As the name implies, an induced
tachycardia in persons who have either an ICD or pacemaker. This is a
fairly rare tachycardia since the development of features in newer
pacemakers. Anytime a pacemaker or ICD feels they have a racing heart
rate it should be checked out by their EP.
PSVT: Paroxysmal Supraventricular Tachycardia; Paroxysmal means abrupt
onset and termination. SVT is an abbreviation for Supraventricular
Tachycardia. This is a tachycardia that originates above the ventricles.
It is often difficult to distinguish the difference between SVT and
ventricular tachycardia by looking at the EKG signals.
PVC: Premature Ventricular Contraction; occurs when the electrical
signal that causes the muscle to contract comes too soon. The ventricle
does not have enough time to fill before contracting. When PVC’s occur
several times in a row and too close together, there is a danger of
developing ventricular tachycardia or ventricular fibrillation. Although
everyone has PVC’s, persons with damaged heart muscle have many more.
SCD: Sudden Cardiac Death; a condition in which the heart develops a
lethal arrhythmia and is unable to pump enough blood to sustain life. If
untreated, the person with these lethal arrhythmias will die in minutes.
The most lethal arrhythmia is ventricular fibrillation. It is different
from a heart attack; a heart attack is a condition where blood vessels
that supply blood to the heart are blocked and cause the heart muscle to
die (that is the plumbing of the heart is defective). In sudden cardiac
death, the electrical system of the heart is defective.
SSS: Sick Sinus Syndrome; also called sick sinus node dysfunction. A
condition where the natural pacemaker of the heart (the sinus node or SA
node) initiates slow or irregular heart beats. Persons with this
syndrome, if symptomatic, are surgically implanted with a pacemaker.
SV: Stroke Volume; the amount of blood ejected by the ventricle in one
contraction. The stroke volume times the beats per minute is the cardiac
output.
SVT: Supraventricular Tachycardia; a tachycardia that is initiated above
the ventricles. It includes atrial tachycardia, atrial flutter and
reentrant tachycardia that are not ventricular. It tends to be a catch
all phrase of those arrhythmias that are not easily distinguishable from
each other with an EKG.
VF: Ventricular Fibrillation; a lethal arrhythmia in which the muscle
cells of the ventricles contract at a different rate resulting in a
‘quivering’ of the ventricles. There is little or no cardiac output. A
person in VF will live only 4-6 minutes before brain death occurs. A
person with VF is said to be experiencing sudden cardiac death. VF can
occur without warning. It is also the hardest arrhythmia to defibrillate
back into a normal sinus rhythm. Electrophysiologists usually test ICD's
by putting the patient into VF and defibrillating the patient to see how
many joules it will take to get the patient out of VF.
VP: Ventricular Pace; when a pacemaker or ICD paces the ventricles
(stimulates it to contract).
VS: Ventricular Sense; when a pacemaker or ICD senses depolarization of
the ventricles when the heart depolarizes on it’s own. The muscle must
depolarize to initiate a contraction.
Credit
to: (We only wish to preserve and save the important work they are
doing) http://www.zaplife.org/
Duplication & Distribution with Attribution
Encouraged
http://www.duff.net/duffey/
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