상급종합병원 간호사의 인공심박동기 관련 지식과 교육요구도

하지혜,강숙정 병원간호사회 2018 임상간호연구 Vol.24 No.2

Purpose: This study aimed to examine nurses’ knowledge levels and educational needs related to an artificial pacemaker. Methods: Participants were 100 nurses working in cardiovascular departments from two university hospitals in Seoul. This study was a descriptive study using a survey for estimating knowledge levels and educational needs related to an artificial pacemaker among nurses. Data were analyzed by SPSS 23.0 program using frequency, percentage, mean and standard deviation, t-test, and ANOVA. Results: Nurses’ knowledge levels were significantly different depending on working units (F=3.32, p=.014) and years of clinical experience (F=2.85, p=.042). Nurses who received education about an artificial pacemaker were higher in the knowledge level of complications after an implantation procedure (t=3.45, p<.001) than nurses who did not receive the education. Conclusion: Discharge education is critical for patients with artificial pacemaker implantation to go back to their daily activities. When developing artificial pacemaker education program for hospital nurses, factors such as nurses’ working department and years of clinical experience years and updated information of an artifical pacemaker need to be considered.

소아연령군에서의 영구 심외막 심박 조율 13년 경험

이정렬,한국남,임홍국,김웅한,김용진,노준량,배은정,노정일,윤용수,안규리 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.6

배경: 본 연구에서는 소아연령군에서 과거 13년 동안 시행한 심외막 인공 심박 조율 수술의 임상경험을 바탕으로 인공 심박동기의 평균 수명, 역치, 재수술의 원인 등을 알아보고자 하였다. 대상 및 방법: 1989년 1월부터 2002년 7월까지 영구 심박 조율기 또는 전극의 이식을 시행한 83명의 환아에게 시행한 121예의 수술을 대상으로 하였다. 후향적으로 환자의무기록을 조사하여 심박 조율기의 수명, 자극 역치, 저항, R파, P파, 감지 역치 등을 조사하였다. 결과: 수술 당시 측정한 평균 심실 자극역치는 1.2 0.1 (0.1∼5) mV, 평균 저항은 519.1 18.1 (319∼778) ohm, 평균 심실 R파 감지역치는 8.9 0.7 (4∼20) mV, 평균 P파 감지역치는 2.5 0.7 (0.4∼12) mV이었다. 심박 조율기의 평균 수명은 64.7 3.7 (2∼196)개월이었다. 심박 조율기 무재수술률은 1년 94.6%, 2년 93.6%, 5년 80.8%, 7년 63.7%, 10년 45.4%였다. 재수술의 원인은 전지 고갈이 26예, 전극 이상이 9예 등이었다. 심박 조율기 삽입 후 이의 오작동과 관련된 수술 후 조기 사망은 없었다. 결론: 소아연령군에서 심외막 심박 조율기 삽입 후 재수술 없이 이를 사용할 수 있는 비율은 비교적 만족할 만한 수준으로 19.1%의 환자만이 5년 내에 재삽입이 필요했다. 스테로이드 용출 전극의 재수술률은 6.7%로 이는 심외막 심박 조율기의 수명을 늘리는 데 도움이 될 것으로 생각된다. Background: We investigated the longevity, thresholds of epicardial pacemaker and causes of reoperation in the pediatric patients who underwent epicardial pacemaker implantation performed during the last 13 years Material and Method: 121 operations were performed in 83 patients from January 1989 to July 2002. We analyzed the stimulation threshold, resistance, R-wave and P-wave, and sensitivity of pacemaker lead at initial implantation. Longevity and causes of reoperations were investigated. Result: At implantation, epicardial ventricular mean stimulation threshold was 1.2±0.1 (0.1~5) mV, mean resistance was 519.1±18.1 (319~778) Ohm, and mean R-wave sensitivity was 8.9±0.7 (4~20) mV, and mean P wave sensivity was 2.5±0.7 (0.4~12) mV. The mean longevity of pacemaker generator was 64.7±3.7 (2~196) months. The reoperation free rate was 94.6% for 1 year, 93.6% for 2 years, 80.8% for 5years, 63.7% for 7 years, and 45.5% for 10 years. The causes of reoperation were battery waste in 26 cases and lead malfunction in 9 cases. There was no postoperative death related to pacemaker malfunction. Conclusion: In the childrens, average longevity of epicardial pacemaker was within acceptable range. 19.1% of the patients required pacemaker related reoperation. However, recent developments, including steroid eluting lead, 6.7% of the patients required pacemaker related reoperation, look promising in expansion of pacemaker life span.

Noninvasive Pacemaker Stress Echocardiography as a Screening Test for Coronary Artery Disease in Patients

윤희정,허성호,도경락,이종민,진승원,윤호중,이만영,승기배,노태호,김재형 대한심장학회 2008 Korean Circulation Journal Vol.38 No.3

Background and Objectives: Making the noninvasive diagnosis of coronary artery disease in patients with a permanent pacemaker is difficult because of the inability to interpret electrocardiograms and the low specificity of perfusion scintigraphy. We evaluated the diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) as a screening test for coronary artery disease in patients with atypical angina and a permanent pacemaker. Subjects and Methods: This a prospective study, and transthoracic stress-pacing echocardiography was performed on 15 patients (9 men and 6 women; age, mean age: 71.1±11.0 years) with atypical angina and a permanent pacemaker. All the patients underwent noninvasive pacemaker-stress echocardiography by external programming (pacing the heart rate up to 150 beats per minute). Coronary angiography was performed on the 8 patients with positive PASE results. Significant coronary artery disease was defined as ≥70% stenosis in at least one major coronary artery. Results: The echocardiographic images were interpretable for all the patients. No significant side effects were observed. The left ventricular systolic function was preserved in all the patients (left ventricular ejection fraction; 63.5±8%). Only 5 (62.5%) of 8 patients showed significant coronary artery disease, as documented by coronary angiography. Conclusion: Noninvasive PASE is a simple, rapid, safe and diagnostically efficient test for detecting coronary artery disease in patients with atypical angina and a permanent pacemaker. Larger studies are necessary to validate our findings. (Korean Circ J 2008;38:140-143)

A Case Report of Rare Complications after Epicardial Permanent Pacemaker Implantation in an Infant: Airway Compression, Skin Necrosis, and Bowel Perforation

김우중,곽재건,민준철,김웅한 대한흉부외과학회 2020 Journal of Chest Surgery (J Chest Surg) Vol.53 No.2

Insertion of an epicardial pacemaker is a useful treatment for pediatric patients with an abnormal heart rhythm. However, there are limitations and concerns when implanting epicardial pacemakers in infants and neonates due to their small body size. We report a patient who experienced rare complications after implantation of a permanent pacemaker.

동기능 부전을 동반한 MELAS 증후군

민지현 ( Ji Hyun Min ),안종화 ( Jong Hwa Ahn ),이정미 ( Jeong Mi Lee ),박정랑 ( Jeong Rang Park ),고진신 ( Jin Sin Koh ),황진용 ( Jin Yong Hwang ),곽충환 ( Choong Hwan Kwak ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2

A 35-year-old male patient with heart and renal failure and pneumonia was transferred to our department due to recurrent cardiac standstill with syncope. He had been diagnosed as and treated for MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) syndrome for the past 3 years. Electrocardiography (ECG) showed the Wolff-Parkinson-White pattern, and an echocardiogram showed hypertrophic cardiomyopathy. He developed syncopal attacks intermittently, and ECG monitoring showed intermittent bradycardia. His Holter monitoring showed several episodes of 5-16 seconds of sinus arrest. We conducted an electrophysiological study to evaluate the arrhythmia. During atrial and ventricular extra-stimuli, cardiac standstill developed several times, and the duration of pauses varied from 2.5 to 5.5 seconds. Abrupt asystolic events also developed accompanying syncopal attacks that were not related to the extra-stimuli. We decided to implant a permanent pacemaker. The patient`s syncopal episodes disappeared after implantation of a DDD type pacemaker. (Korean J Med 2013;84:265-268)

영구 경정맥 심박조율기 도자에 의한 우심실 천공과 좌측 혈흉 -1예 보고-

김재현,나찬영,김근직,오삼세,백만종,김종환 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.4

Bleeding due to cardiac perforation by endocardial pacemaker lead is a rare complication. We report one case of left hemothorax due to right ventricular perforation after the insertion of permanent transvenous pacemaker. Operative finding showed a pacing lead penetrating right ventricle, pericardium, and left pleura sequentially, but there was no evidence of hemopericardium. 심내막 심박조율기 이식 후 도자에 의한 심장 천공으로 출혈이 발생하는 경우는 드물다. 본원에서는 영구 경정맥 심박조율기 이식 후 우심실 천공에 의한 좌측 혈흉이 발생하였던 환자를 경험하였기에 보고하는 바이다. 수술 소견 상 심박조율기 도자가 우심실 천공 후 심낭막과 흉막을 차례로 관통하였으나 혈심낭 소견은 관찰되지 않았다.

영구 경정맥 심박조율도관의 심장내 이동과 동반된 심내막염 -1례 보고-

구관우,강신,김시욱,유재현,나명훈,임승평,이영 대한흉부외과학회 2002 Journal of Chest Surgery (J Chest Surg) Vol.35 No.11

감염된 심박조율기의 부분적 제거 후에 발생되는 재감염율은 51%에서 77%에 이르기 때문에 심박조율기의 어느 부위라도 감염이 된다면 모든 심박조율기의 하드웨어는 제거되어야 한다. 심폐기 가동하에서 감염된 심박조율기를 제거하는 것은 감염과 증식물의 확산 뿐만 아니라 기계적 손상을 방지 할 수 있다. 저자 등은 좌쇄골하 정맥에서 심장내로 이동된, 감염된 경정맥 심박조율기 도관에 의해 발생한 심내막염의 1예를 보고한다. 심장내로 이동된 심박조율기 도관과 증식물이 부착된 전극은 심폐우회를 이용하여 제거하였다.영구적 심내 심박조율기 설치에 따른 합병증이 다양하고 발생 빈도가 높기 때문에 이식한 심박조율기의 수명을 연장시키고 심박조율기 기능이상을 사전에 알아내기 위한 환자의 추적 관리가 필수적이다. 근자에 와서 심박조율기의 이식이 증가함에 따라 심박조율기 clinic이 설치되어 정기적 심전도 모니터, X-선 검사, 전해질의 측정 등을 하고 있으며, 또한 transtelephone을 이용하여 환자와 의사간의 편리를 도모하고 있는 추세이다7). Endocarditis with Intracardiac Migration of TransvenousPermanent Pacing Lead- 1 Case Report -

증례 : 순환기 ; 임시형 심박조율기 삽입 후 발생한 조율 허용성 다형 심실빈맥 1예

박재영 ( Jae Young Park ),곽성동 ( Seong Dong Kwak ),임주견 ( Ju Kyeon Yim ),정재식 ( Jae Shik Jeong ),천재홍 ( Jae Hong Chun ),최성열 ( Sung Yeol Choi ),정준훈 ( Joon Hoon Jeong ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

저자들은 하벽의 급성 심근경색증 환자에서 VVI 방식의 임시형 심박조율기를 삽입한 후 심박조율기 오작동으로 인한 조율 허용성 다형 심실빈맥을 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다. A 74-year-old man was admitted with sudden-onset chest pain. Electrocardiography showed ST segment elevation in leads II, III, and aVF; in addition, the levels of several cardiac enzymes were elevated. The patient received a VVI temporary pacemaker due to bradycardia (45 beats/min) and was subjected to primary percutaneous coronary intervention. After percutaneous coronary intervention for the RCA infarction, the patient was admitted to the coronary care unit. Six hours later, polymorphic ventricular tachycardia occurred following a short-long-short sequence. This is the first case of temporary pacemaker-permitted ventricular tachycardia in Korea. Here we present a case of pacemaker-permitted polymorphic ventricular tachycardia in a patient with inferior acute myocardial infarction. (Korean J Med 77:S1157-S1161, 2009)

Permanent Pacemaker Implantations after Catheter Ablation in Patients with Atrial Fibrillation Associated with Underlying Sinus Node Dysfunction

Tae Hyun Hwang,Hee Tae Yu,Taehoon Kim,Jae-Sun Uhm,Jong-Youn Kim,Boyoung Joung,Moon-Hyoung Lee,Hui-Nam Pak 대한심장학회 2020 Korean Circulation Journal Vol.50 No.4

Background and Objectives: The objective of this study was to evaluate the long-term clinical outcomes and the incidence of permanent pacemaker implantation after catheter ablation in patients with of atrial fibrillation (AF) and sinus node dysfunction (SND). Methods: Among 3,068 total consecutive patients who underwent AF catheter ablation (AFCA), this study included 222 (9.5%; men 53.2%, 63.7±9.2 years of age, 81.5% paroxysmal AF) with underlying SND and a regular rhythm follow-up. We analyzed the rhythm outcomes, changes in the mean heart rate or heart rate variability, and permanent pacemaker implantation rate. Results: During 47.5±28.8 months of follow-up, 25 (11.3%) patients received pacemaker implantations due to symptomatic SND. More than half (56.0%, 14/25) underwent a pacemaker implantation within 3 months of the AFCA, and the annual pacemaker implantation rate was 2.0% afterwards. Both the early (68.0% vs. 31.0%, p<0.001) and clinical AF recurrence (68.0% vs. 32.5%, p=0.001) rates and continuous antiarrhythmic drug use after 3 months (44.0% vs. 24.4%, p=0.036) were significantly higher in patients requiring pacemaker implantations than those that did not. An anterior linear ablation (odds ratio [OR], 9.37 [3.03–28.9]; p<0.001) and the E/Em (OR, 1.15 [1.02–1.28]; p=0.018) were independently associated with permanent pacemaker implantations after AFCA in patients with AF and SND. Conclusions: After AFCA in patients with AF and SND, 1 of 9 patients needed a pacemaker implantation and half needed implantations within 3 months. The AF recurrence rate was significantly higher in those who required pacemaker implantations after the AFCA.

Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study

Elhaddad Ahmed Mohamed,Hefnawy Salwa Mohamed,El-Aziz Mohamed Abd,Ebraheem Mahmoud Mostafa,Mohamed Ahmed Kareem 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.5

Background: Postoperative pain management after pacemaker insertion routinely requires opioid agents, nonsteroidal anti-inflammatory drugs, or paracetamol. However, interest in opioid-sparing multimodal pain management to minimize postoperative narcotic use has increased recently. This study aimed to assess the pectoral nerve (PECS) block versus standard treatment on postoperative pain control and opioid consumption in pediatric patients after transvenous subpectoral pacemaker insertion.Method: In this randomized controlled study, 40 pediatric patients underwent transvenous subpectoral pacemaker insertion with either congenital or postoperative complete heart block. Patients were randomly assigned to two groups: Group C (control) received conventional analgesic care without any block and Group P (pectoral) received a PECS block. Demographics, procedural variables, postoperative pain, and postoperative opioid consumption were compared between the two groups.Results: In children undergoing transvenous subpectoral pacemaker insertion, the PECS block was associated with a longer procedure time; however, the cumulative dose of fentanyl and atracurium was reduced and the hemodynamic profile was superior in Group P compared with Group C intraoperatively. Postoperatively, the PECS block was associated with lower postprocedural pain scores, which was reflected by the longer interval before the first call for rescue analgesia and lower postoperative morphine consumption, without an increase in the rate of complications.Conclusion: Ultrasound-guided PECS blocks are associated with a good intraoperative hemodynamic profile, reduced postoperative pain scores, and lower total opioid consumption in children undergoing transvenous subpectoral pacemaker placement.