PPM Medical Abbreviation

The medical abbreviation of PPM is Permanent Pacemaker. A permanent Pacemaker (PPM) is a small metallic electrical device implanted under the skin below the clavicle of the non-dominant side, designed to maintain a normal regular rhythm in a patient having rhythm abnormalities, particularly bradycardia & heart block. Among the different meanings of the PPM abbreviation, Permanent Pacemaker (PPM) is the most common one & mostly used. PPM is the common medical abbreviation for Permanent Pacemaker used in medical terms.  Before diving into the detail of a Permanent Pacemaker (PPM), let's discuss the basics of the pacemaker.

Pacemaker:

A pacemaker is a small, electronic medical device used to regulate and control the heart's electrical activity. The pacemaker is implanted under the skin, usually in the chest area below the collar bone (the clavicle) over the pectoral muscle, and connected to the heart through thin wires called leads.

Purpose of pacemaker:

The primary purpose of a pacemaker is to treat and manage abnormal heart rhythms, also known as arrhythmias. These abnormal rhythms can result from problems with the heart's electrical system, causing it to beat too slowly (bradycardia) or too quickly (tachycardia).

How Pacemaker Works:

The working principle of a pacemaker is it continuously monitors the heart's electrical activity. When it senses a slow heart rate or the absence of electrical signals, it sends a low-energy electrical impulse through the leads to stimulate the heart muscle, helping it to beat at a regular rate.

Permanent Pacemaker (PPM):

A permanent pacemaker (PPM) is a small, flat metal device designed to regulate that is implanted under the skin usually in the pectoral area, and controls the heart's electrical activity for patients with certain heart rhythm disturbances, particularly those involving bradycardia (slow heart rate) or heart block. Unlike temporary pacemakers used in acute settings, permanent pacemakers (PPM) are implanted for long-term management.

Permanent pacemakers (PPM) contain a pulse generator, lead/wire, and programmable electronics that allow adjustment of pacing and memory functions. Pacing electrodes can be placed via subclavian or cephalic veins into the right ventricle (usually at the apex), the right atrial appendage or to maintain AV synchrony, both. An external programmer through a wireless telemetry system is used to control permanent pacemakers allowing rate, output, timing, and other parameters to be adjusted. This allows the device set to be tailored to the patient's needs.


Indications Permanent Pacemaker (PPM):

Permanent pacemakers are indicated for several cardiac conditions, including:
1. Sino-atrial Node Dysfunction: When the heart's natural pacemaker, the sinus node, fails to generate electrical impulses normally, a pacemaker can help maintain an appropriate heart rate.
2.  Second or third Atrioventricular (AV) Block: This condition occurs when the electrical signals between the upper chambers (atria) and lower chambers (ventricles) of the heart are delayed or blocked. A pacemaker can help ensure the coordination of electrical impulses between the chambers.
3. Bradycardia-Tachycardia Syndrome: In patients with alternating slow and fast heart rhythms, a pacemaker can stabilize the heart rate.
4. Heart Failure: Some individuals with heart failure may benefit from a specific type of pacemaker called a biventricular pacemaker (cardiac resynchronization therapy), which helps improve the heart's pumping efficiency.
5. Patients with continuous atrial fibrillation.


Implantation Procedure of Permanent Pacemaker (PPM):

The implantation of a permanent pacemaker (PPM) is a minor surgical procedure typically performed under local anesthesia with light sedation. The following steps are done in the implantation procedure of a permanent pacemaker (PPM):
1. Incision: A small incision is made near the collarbone or below the pectoral muscle.
2. Lead Placement: One or more leads (thin, insulated wires) are threaded through a vein and guided to the heart's chambers. The leads are then attached to specific sites on the heart wall.
3. Pacemaker Placement: The pacemaker generator, containing the electronic circuitry and battery, is placed under the skin near the incision site and connected to the leads.
4. Testing and Verification: The pacemaker is tested to ensure proper functioning, and the settings are adjusted according to the patient's needs.
5. Incision Closure: The incision is closed with sutures or adhesive strips.


Permanent Pacemaker (PPM) Function:

Once implanted, the permanent pacemaker (PPM) continuously monitors the heart's electrical activity. When the heart rate drops below the programmed threshold or if other arrhythmias are detected, the pacemaker delivers small electrical impulses through the leads to the heart muscle, causing the heart to beat at a desired rate and rhythm. Aside from their therapeutic role, pacemakers store useful diagnostic data about the patient's heart rate trends and the occurrence of tachyarrhythmia such as ventricular tachyarrhythmia.


Post-Implantation Care and Follow-Up after Permanent pacemaker (PPM) placement:

Patients require regular follow-up visits with their cardiologists or electrophysiologists after permanent pacemaker (PPM) implantation. These visits are essential for monitoring the pacemaker's function, checking battery life, adjusting settings as needed, and ensuring the patient's overall well-being.

As a health practitioner, it's crucial to understand the indications, implantation procedure, and post-implantation care of permanent pacemakers (PPM) to effectively manage patients with these devices in clinical practice.

Single chamber pacing is indicated in patients with a sinuatrial disease without atrioventricular block and also in a patient with atrial fibrillation and bradycardia. Here the pacemaker act as an external sinus node.

Dual chamber pacing is most often used in patients with second or third-degree heart block. Here atrial electrode is used to detect spontaneous atrial activity and trigger ventricular pacing. Dual chamber pacing has many advantages over ventricular pacing which include superior hemodynamics and better effort tolerance, avoidance packer syndrome in which there is dizziness and fall in blood pressure occur due to loss of AV synchrony.

A code is used to signify the pacing mode (for example a system that paces the atrium, senses the atrium, and is inhibited if it senses spontaneous activity is designated by AAI.)
international generic pacemaker code.

Chamber paced	CHAMBER SENSED	RESPONSE TO SENSING
O: NONE	O: NONE	O: NONE
A: ATRIUM	A: ATRIUM	T: TRIGGERED
V: VENTRICLE	V: VENTRICLE	I: INHIBITED
D: BOTH	D: BOTH	D: BOTH

 

Complications of Permanent pacemakers (PPM):

A. Early

• Pneumothorax
• Cardiac tamponade
• Infection
• Lead displacement

B. Late

• Infection (which usually necessitates removing the pacing system)
• Erosion of generator or lead
• Chronic pain related to implanted site
• Lead fracture due to mechanical fatigue