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Dual pace maker is indicated for this patient because he has had an MI 2 years ago and may suffered damage to the conduction system may have a bifascicular block where 2 bundles of the heart start to malfunction and they cause arrhythmia. Also even though amioderone is working temporarily you can't keep patients on this med long term.

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https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015176/

https://www.nice.org.uk/guidance/ta88

http://emedicine.medscape.com/article/1839735-overview

http://www.webmd.com/heart-disease/guide/abnormal-rhythyms-pacemaker#4

http://anesthesia.slu.edu/pdf/pacemaker.pdf

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"Dual-chamber pacemakers have two leads, placed in the right atrium and right ventricle. They act synchronously when a slow natural HR is detected to mimic the sequential physiological contraction of the atria and ventricles". (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015176/)
The pacemaker can also slow down the HR when it beats over the set amount.

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"Dual-chamber pacemaker – With this device, 2 pacing leads are implanted (1 in the right ventricle and 1 in the right atrium); this is the most common type of implanted pacemaker"(http://emedicine.medscape.com/article/1839735-overview)
1. can be placed in by means of the epicardial approach which is most common for children in which the lead tip wire is attatched to the heart muscle and then a pocket is made in the abdomen just under the skin.
2. can be placed via the endocardial apporach which is the most common for adults where the lead tip wire is attached to the heart muscle and a pocket is made in the upper chest underneath the skin.

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In DDD pacemakers, atrial paci

ng is in the inhibited mode (the pacing device

will emit an atrial pulse if the atrium does

not contract). In DDD and VDD pacemakers,

once an atrial event has occurr

ed (whether paced or native)

the device will ensure that an

atrial event follows.

I - (inhibited): The device will pulse to the app

ropriate chamber unless it detects intrinsic

electrical activity. In the DDI program,

AV synchrony is provided only when the atrial

chamber is paced. If on the other hand if intr

insic atrial activity is present, then no AV

synchrony is provided by the pacemaker.

T - (triggered): Triggered mode is only used

when the device is being tested. The pacing

device will emit a pulse only in

response to a sensed event.

The VDD pacemaker is used for AV nodal dysf

unction but intact and appropriate sinus

node behavior. DDI is rarely used as the primar

y mode of pacing. The DDI pacer is used for a

patient with a dual-chamber pacemaker that has ep

isodes of paroxysmal atrial fibrillation. DDI

prevents high ventricular rates. Some DDD pacemakers are programmed to enter the DDI mode

when high atrial rates occur.

The fourth position, rate modulation, increase

s the patient’s heart rate in response to

“patient exercise”. A number of mechanisms

(vibration, respiration, and pressure) are used to

detect “patient exercise”. As

the exercise wanes, the sensor indicated rate returns to the

programmed mode.

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What happens with Hypertension/ Hypotension

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What happens with Hypertension/ Hypotension

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In Hypertension even with the pacemaker effectively pumping your heart for you your C.O. will be decreased.
In Hypotension the vessels will constrict causing the hearts natural pacemaker to compete with the man made pace maker causing arrythmias.

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things that the patient will have to watch out for after implantation of the pacemaker until surgical site is fully healed:
Increased drainage, bleeding, or oozing from the insertion site

Increased opening of the incision

Redness around the site

Warmth along the site

Increased body temperature (fever or chills
Other things to monitor and to notify your doctor of:
rapid HR over your set rate consistently, slower HR over your set rate, and consistent arrythmias

A pacemaker will help the patients ability to be able to have a semi controlled HR that will allow the patient to exercise without running the risk of a racing HR or too slow of a HR so they will be able to have a better delivery of blood and oxygen to the rest of the body. Will reduce the need for antiarrythmics that have high side effects.

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1.Bleeding

2.Hematoma

3.Phlebitis or thrombophlebitis of the vein

4.Local infection

5.Arterial injury or puncture

6.Hemothorax
7. Pneumothorax

8. Catheter-related thrombosis (which may lead to pulmonary embolism)

9.Air embolism

10.Dysrhythmias

11.Atrial wall puncture from guide wire (which may lead to pericardial tamponade)

12.Lost guide wire 13.Anaphylaxis

14. Chylothorax (possible with left-side lead insertion)

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1. When a patient has symptomatic bradycardia and its caused by sick sinus syndrome but the electrical impulses between the upper and lower chambers of the heart are normal ( a single chambered pacemaker would be indicated).
2. When the patient has AV block and causes symptomatic bradycardia and they have continuous AFIB ( a single chambered pacemaker should be used
3.  Local infection at implantation site
4. Active systemic infection with bacteremia.
5. Severe bleeding tendencies (relative contraindication
6. Active anticoagulation therapy (relative contraindication
7. Severe lung disease and positive end-expiratory pressure ventilation (relative contraindication for internal jugular and subclavian access)

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1. Dual chambers are used to treat symptomatic bradycardia with people who have sick sinus syndrome, atrioventricular block, or they could have both.
2. " Pacemaker syndrome refers to a group of symptoms that includes nausea, palpitations, chest pain, fatigue, breathlessness, pre‑syncope and syncope. The underlying cause of pacemaker syndrome is not fully understood. It is thought to be caused by loss of the heart's natural AV sequence, causing simultaneous contraction of the atria and ventricles"  Severe pacemaker syndrome can be eradicated by an upgrade to a dual‑chamber pacemaker"(https://www.nice.org.uk/guidance/ta88/chapter/2-Clinical-need-and-practice)
3. Chronic bifascicular block

4.After an acute myocardial infarction

5.Hypersensitive carotid sinus syndrome and neurocardiogenic syncope

6.After cardiac transplantation

Pacing to prevent tachycardia

Patients with congenital heart disease