I have almost 11 years years experience in treating EECP patients and many have pacemakers.
1. If you have a patient with the 'rate response mode" turned on , usually you need to cancel that particular setting for the treatment hour. If not, usually a few minutes after you start treatment their PM rate will slowly climb to >100 bpm since the pacemaker mistakenly thinks that the patient is up and exercising due to the chest wall movement during EECP. Eg: Set a DDDR pacer to DDD for the hour, VVIR to VVI, etc. You then return them to their original mode after each traeatment, unless your physician agrees to keep the rate response off for the whole 35 treatments. Of course you have to have the PM programmer available to do this. If you do not, then talk to your physician about placing a magnet over the PM during the ytraetment. This will also change the setting. Discuss these changes with your physician before attempting them. Also make sure the patient understanding that you are "changing" some settings to give them a better experience with EECP. Avoid telling them you are "shutting off or turning off or deleting" something. Many patients don't understand and think you have turned off their pacemakers and they are panicky during treatment, but may not verbalize that to you.
2. Another problem can be a PM patient with a competing intrinsic rhythm or underlying AF. They can often have a "rough ride". Often in addition to cancelling rate response for treatment, often you can "override" the intrinsic rhythm by increasing the PM base rate. For instance, A DDDR patient with a base rate of 60 -70 (most common settings) may improve with a setting of DDD - rate 80 - 85. Again your physician will have to approve. Return to original settings post-treatment.
3. Patient with or without PM who have either a changing rhythm or frequent APCs / PVCs may also benefit from trying different lead placements or configurations. I try to find the lead placement for the underlying rhythm that best "resembles" the arrhythmia. I use all possible combinations of black & white electrodes either on shoulders, below breast line & mid-sternal to "mimic" the shape, width &/or upward / downward slope of QRS. The patient may still have pauses her and there but the machine tends not to totally stop so often and give them the "big squeeze" they all complain about.
I hope these ideas help you. Please also visit the IETA (International ECP Therapists Association) website at www.ietaonline.com
for other information & membership.
Joanne Giordano, LPN, CET