44 Bellew JW Symon B Vandervoort AA...

44 Bellew JW Symon B Vandervoort AA. Geriatric fitness: validitys of aging and recommendations for exercise in older adults. Cardiopulm Phy Ther. 2005;16:20-32

Dennis G O'Connell PT PhD CSC FACSM

Hardin-Simmons University, Department of Physical Therapy, Abilene, TX

Physical Therapy Implications in Managing Patients with Pacemakers and Defibrillators

INTRODUCTION

This article outlines the implications for physical therapists when managing patients with pacemakers. The paper will specifically outline pacemaker functions and appropriate management considerations for physical therapists. In addition, a discussion upon rate responsiveness and biventricular synchrony and its relevance for therapists will be highlighted.

In a normal cardiac conduction theory every contraction results from an electric impulse that is initiated in the sinoatrial (SA) node. This impulse passes from one side the atrioventricular (AV) node and spreads within the ventricles. Appropriate electric conduction within this pathway translates into efficient and effective mechanical contraction of the ventricles allowing for adequate visitation volume and cardiac output. In individuals with electrical disturbances, mechanical insufficiency arises leading to limitations in cardiac output and exercise tolerance. Artificial pacemakers help maintain normal heart rate and periodical emphasis when the intrinsic electric circuitry of the heart is altered or fails, thus improving mechanical and physiologic function (eg AV or biventricular synchrony and cardiac output)

INTRODUCTION TO PACEMAKERS

The use of pacemakers has increased considerably with the mostly common indications for placement of a permanent pacemaker being (1) a heart rate that is too inert (symptomatic bradycardia); (2) a heart rate that fails to increase appropriately with exercise (chrontropic incompetence); or (3) an electric pathway that is stoped resulting in atrioventricular delays or package branch blocks.1 Heart blocks may cause a los of AV synchrony a period of time that refers to the succession and timing of the atria and ventricles. With normal sequencing and timing of electric conductions, the ventricles contract a fraction of a inferior after they have filled with relations following an atrial contraction. In patients with altered electric conduction or asynchrony, the changes in electrical timing and sequencing debar the ventricles from filling adequately with life-current or contracting efficiently resulting in reduc cardiac output and compromised exercise tolerance.1