Unconventional applications in pacemaker therapy

Update on implantable pacemakers

There are currently more than 3 million patients worldwide with implanted pacemakers, and indications for implants are expanding. Pacemakers today are smaller (23-30 g) and fashioned in a more physiologic shape so as to be less obtrusive. They are replete with sophisticated diagnostic and programming features that make troubleshooting of complicated arrhythmias easier. Advanced nurse clinicians need to have a basic understanding of pacemaker function, indications for implantation, an awareness of potential complications, and facility with basic troubleshooting. The purpose of this article is to describe the features of the pacemakers available today and approaches to troubleshooting these devices.

Usability assessment of pacemaker programmers

There is a perception among clinicians of usability differences in the user interface of pacemaker programmers, but there is an absence of literature in this area. The purpose of this study was to describe usability differences in pacemaker programmers. Forty-two programmer users completed self-administered questionnaires and two usability experts independently performed heuristic evaluation to identify features that violated general usability principles. Programmers from seven manufacturers (coded A-G) were evaluated. There was a balanced representation of users: nurses (58%) versus technologists (40%) who are employed in community (50%) versus academic (45%) hospitals, novice versus expert users based on the median users' programming experience of 60 months (range 1-300 months). Significant differences between programmers were found in overall user satisfaction and ease of programmer use (P < 0.0001) in the display, controls, operation, and physical dimension of the programmers (P < 0.05). Heuristic evaluations showed frequent violations of usability principles in all programmers. Problematic areas include reliance on user recall, inconsistency in operation of critical controls, poor readability, and not anticipating user wants or action. Programmer interface designs do not consistently meet user needs or general usability principles. This impacts on the safe and effective use of programmers. Guidelines in programmer design should be established, particularly with respect to labeling, location, and operation of critical controls.