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EP > ACCSAP EP > Flashcards

ACCSAP EP Flashcards

1
Q

what is the most common cause for hospitalization in patients over the age of 65

A

heart failure

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2
Q

what uses an LV pacing lead to mitigate ventricular conduction delay to improve mechanical function in patients with systolic heart failure

A

CRT

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3
Q

which area is the last to electrically activate in normal conduction of the heart

A

lateral RV

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4
Q

when LBBB is present, how is the septum activated

A

right to left

most significant delay in posterior-lateral free wall of LV

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5
Q

which valvular disorder can be improved with CRT

A

mitral regurgitation

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6
Q

intraventricular DYSsynchrony results in these 4 things

A
  1. decreased CO
  2. decreased MAP
  3. decreased LVEF
  4. decreased ratio of change in pressure to change in time (dP/dt)
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7
Q

which modality is MOST useful to evaluate mechanical dyssynchrony?

A

EKG

not echo

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8
Q

which type of wide QRS complex derives the most benefit from CRT

A

LBBB

RBBB and IVCD have variable degrees of LV conduction delay and service less benefit

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9
Q

biventricular pacing improves synchrony which results in more effective

A 
systolic function 
(improve EF, stroke volume, CO)
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10
Q

name some trials supporting the use of CRT in patients with severe Class III-IV HF

A

MIRACLE
COMPANION
CARE-HF

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11
Q

name the trials that showed that CRT was not beneficial, and could be harmful in patients with narrow QRS and depressed EF

A

RethinQ
LESSER-EARTH
EchoCRT

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12
Q

which EKG characteristics if present will likely predict positive response to CRT (2)

A

LBBB type conduction

QRS >150 msec

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13
Q

list reasons for nonresponse to CRT

A 
suboptimal AV timing
arrhythmias (fib or frequent PVCs)
suboptimal med rx 
<90% biV pacing
LV lead noncapture
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14
Q

according to guidelines, what is a class I recommendation for receiving CRT
***

A

NSR
NYHA class II-III or ambulatory IV
LBBB
QRS>150 msec

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15
Q

according to guidelines, what is a class IIa recommendation for receiving CRT

A

NSR, NYHA II-III or ambulatory IV, LBBB, QRS 120-149 msec

NSR, NYHA III or ambulatory IV, nonLBBB, QRS >150 ms

AFIB and one of the above criteria when near 100% biV pacing is possible (after AVN ablation or with AVN blockers)

New requirement for ventricular pacing when >405 VENTRICULAR PACING IS ANTICIPATED

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16
Q

where is the LV lead of a CRT device placed

A

coronary sinus branch vessel

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17
Q

what is the name for having two sense-pace electrodes on an RV ICD lead spaced a few mm apart (one at the tip and other at the ring)

A

true bipolar

18
Q

what is the name for having one sense-pace electrode on an RV ICD lead at the tip and using the RV coil as the second electrode

A

integrated bipolar

19
Q

which trial demonstrated a mortality reduction of 31% and 61% reaction in arrhythmic death with ICDs in ischemic CM, EF =35% patients in the absence of an EP study

A

MADIT II

20
Q

which 2 trials established the role of ICD indication in patients with NONischemic cardiomyopathy, EF =35% (found 23% mortality reduction in ICD arm)

A

SCD-HeFt

DEFINITE

21
Q

which 2 trials found that there is NO benefit (does not reduce subsequent mortality) with early ICD implantation (within 31 or 40 days) of MI in high risk patients with depressed EF =35-40%

A

DINAMIT

IRIS

22
Q

what are the class I indications for ICD implantation for primary prevention

A

NYHA II-III symptoms
+/- >40 days post MI
LVEF = 35%

If NYHA I symptoms
+/- >40 days post MI
LVEF = 30%
(If LVEF is 35 then it is IIb recommendation)

all patients must have >1 yr life expectancy

23
Q

in patients with HOCM what are the indications for ICD placement (class IIa)

A 
any one of the below:
wall thickness >30 mm
NSVT
syncope
fam hx of SCD
24
Q

when is it appropriate to implant ICD in patients with prolonged QT(IIa)

A

syncope or polymorphic VT despite treatment with beta blocker

25
Q

when is it appropriate to implant ICD in patients with brugada syndrome (IIa)

A

syncope or documented VT

26
Q

when is it appropriate to implant ICD in patients with CPVT (IIa)

A

syncope or documented VT

27
Q

who are the optimal candidates for subQ ICD placement

A

ESRD HD patients who do NOT need

CRT or antitachycardia/bradycardia pacing

28
Q

what are some risks of defibrillator threshold testing (3)

A

refractory VF
embolism from the LA or LV
PEA

29
Q

what are the contraindications to defibrillator threshold testing (6)

A 
intracardiac thrombus
Afib without adequate anticoagulation
high burden of unrevasc CAD
severe pHTN
HF class III-IV
EF <15-20%
30
Q

what is the suggested slowest treatment zone for VT

A

no slower than 185 bpm

31
Q

what are the 2 parameters that are MOST important for tachyarrhythmia related programming

A

rate detection

duration

32
Q

employing what type of criterion will help with discriminating a gradually accelerating sinus tach to avoid getting ICD treatment for it

A

sudden onset criterion

33
Q

what type of criterion can be employed to distinguish regular, monomorphic VT from AFib

A

stability criterion

34
Q

when should tachyarrhythmia discriminators NOT be used ever

A

complete heart block

…because all rapid ventricular rates are due to VT or VF

35
Q

what is it called when the ICD detects both the R and the T wave and registers this as a tachyarrhythmia

A

double counting

36
Q

when programming the lowest VT zone for secondary prevention, how many bpm should you set it below the clinically relevant sustained VT rate

A

10-20 bpms

37
Q

pacing mode nomenclature: what do the first, second, third and fourth letters stand for

A

1st chamber paced (A,V,D)
2nd chamber sensed (A,V,D,O = none)
3rd response to the sensed events
(Inhibit, Triggered, Dual response to either inhibited or triggered)

38
Q

3+ shocks in a 24 hour period is called

A

VT/VF storm

39
Q

which type of infection requires complete extraction of the ICD/PPM system:

  1. pocket infection
  2. lead associated endocarditis
  3. valvular endocarditis from device seeding
A

All of the infections require complete extraction

Only difference is antibiotic duration and the timing of re-implantation

40
Q

RBBB-morphology arrhythmias usually originate from the ___

A

LV

41
Q

LBBB morphology arrhythmias usually originate from the ___

A

RV or interventricular septum

EP (2 decks)

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