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(The exact time will depend on hospital policy.)
    •
    Patients are sedated during the procedure and may
    require time after the procedure to recover.

    S4 AClJH. CARE HANDBOOK FOR I)HYSICAL THERAPISTS
    • MOSt of the postintervenrion care is geared toward
    moniroring for complications. Possible complications
    include bleeding from the access site, cardiac tamponade
    from perforation, and arrhythmias.
    • After a successful ablation procedure (and the initial
    immobility to prevent vascular complications at the access
    site), there are usually no activity restrictions.
    Cardiac Pacemaker Implantation and Automatic Implantable
    Cardiac Defibrillator
    Cardiac pacemaker implanration involves the placement of a unipolar or
    bipolar electrode on the myocardium. This electrode is used to create an
    action potential in the management of certain arrhythmias. Indications
    for cardiac pacemaker implantation include the following'2•47.48:
    • Sinus node disorders (bradyarrhythmias [HR lower than 60 bpmJ)
    • Atrioventricular disorders (complete heart block, Mobitz
    type 11 block)
    • Tachyarrhythmias (supraventricular tachycardia, frequent ectopy)
    Temporary pacing may be performed after an acute MI to help
    control transient arrhythmias and after a CABG. Table 1 - 1 9 classifies
    the various pacemakers.
    One of the most critical aspects of pacer function for a physical therapist to understand is rate modulation. Rate modulation refers ro the pacer's ability to modulate HR based on activity or physiologic
    demands. Not all pacers are equipped with rate modulation; therefore,
    some patients have HRs that may not change with activity. In pacers
    with rate modulation, a variety of sensors are available to allow adjustment of HR. The type of sensor used may impact the ability of the pacer to respond to various exercise modalities. For more detail, the
    teader is teferred to the review by Sharp 48
    Clinical Tip
    • If the pacemaker does not have rate modulation, lowlevel activity with small increases in metabolic demand is

    Table 1-19. Pacemaker Classification
    Fourth Symbol
    Fifth Symbol
    First Symbol
    Second Symbol
    Third Symbol
    Programma biliry/
    Antitachyarrhythmia
    Pacing Location
    Sensing LOC3[ion
    Response to Pacing
    Modulation
    Function
    0 = None
    N = None
    0 = None
    0 = None
    0 = None
    A = Arrium
    A = Atrium
    I = Inhibited
    S = Simple
    P = Pacing
    programmable
    V = Ventricle
    V Ventricle
    T = Triggered
    M = Multi-
    S Shock
    =
    =
    programmable
    D Dual
    D = Dual
    D = Dual
    C = Communicating
    D = Dual
    =
    R = Rate modulacion
    Dual = atrium and ventricle can be sensed and/or paced independently; Inhibited = pending stimulus is inhibited when a sponraneous stimulation is detected; Triggered = detection of stimulus produces an immediate stimulus in the same chamber; Simple programmable = program either rate or output; Mulriprogrammablc = can be programmed more extensively; Communicating = has telemetry capabilicies; Rate modulation = can adjust ute automatically based on one or more physiologic variables.
    Source: Adapted from AD Bernstein, AJ Camm, RD Fletcher, er al. The NASPElBPEG generic pacemaker code for anribradyarrhythmia and adaptive pacing and anritachyarrhythmia devices. PACE 1987;10:795.
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    56
    ACUTE CARE HANDBOOK FOR PHYSICAL THERAI)ISTS
    preferred. Assessment of RPE, BP, and symptoms should be
    used ro moniror rolerance.48
    •
    If the pacemaker does have rate modulation, then the
    type of rate modulation used should be considered":
    • With activity sensors, HR may respond sluggishly to
    activities that are smooth-such as on the bicycle ergometer.
    •
    For motion sensors, treadmill protocols should include
    increases in both speed and grade, as changes in grade
    alone may nOt trigger an increase in HR.
    • QT sensors and ventilarory driven sensors may require
    longer warm-up petiods owing to delayed responses to
    activity.
    • Medication changes and electrolyte imbalance