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Pacemaker
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==== Periodic pacemaker checkups ==== [[File:PaceMakerRemoteMonitoringDevicesTwoKinds.jpg|thumb|Two types of remote monitoring devices used by pacemaker patients]] Once the pacemaker is implanted, it is periodically checked to ensure the device is operational and performing appropriately; the device can be checked as often as is deemed necessary. Routine pacemaker checks are typically done in-office every six months, though will vary depending upon patient/device status and remote monitoring availability. Newer pacemaker models can also be interrogated remotely, with the patient transmitting their pacemaker data using a transmitter at home connected to a cellular telephone network. During in-office follow-up, diagnostic tests may include: * Sensing: the ability of the device to "see" intrinsic cardiac activity (atrial and ventricular depolarization). * Impedance: A test to measure lead integrity. Large and/or sudden increases in impedance can indicate a lead fracture, while large and/or sudden decreases in impedance can be caused by insulation failure. * Threshold amplitude: The minimum voltage (generally in hundredths of volts) required in order to pace the atrium or ventricle connected to the lead. * Threshold duration: The time that the device requires at the preset amplitude to reliably pace the atrium or ventricle connected to the lead. * Percentage of pacing: The percentage of time that the pacemaker has been actively pacing since the previous device interrogation, which shows how dependent the patient is on the device. * Estimated battery life at current rate: As modern pacemakers are "on-demand" and only pace when necessary, battery lifespan is affected by how much the pacemaker is utilized. Other factors affecting battery life include programmed output and algorithms (features) that use battery power. * Any events that were stored since the last follow-up, in particular [[arrhythmias]] such as [[atrial fibrillation]]. These are typically stored based on specific criteria set by the physician and specific to the patient. Some devices have the availability to display intracardiac electrograms showing the onset of an event as well as the event itself, which helps to diagnose its cause or origin.
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