Arrhythmia - Pacemaker, ICD and CRT

Question 1

Class recommendation for Sinus node dysfunction

Answer 1

CLASS I
- Symptomatic at rest
- necessary drug use

Question 2

Pacemaker indication for atrioventricular block
- CLASS III

Answer 2

Question 2

mortality risk in Complete heart block

Answer 2

depends on the level of block

Question 3

For post cardiac surgery, how many days do you wait for recommendation of pacemaker?

Answer 3

at least 5 days if with persistent CHB

Question 3

Pacemaker indication for atrioventricular block
CLASS I

Answer 3

Question 4

Pacemaker indication for atrioventricular block
CLASS IIa

Answer 4

Question 5

Pacemaker indication for Bifascicular Block

Answer 5

Question 6

In patient post TAVR, which new ECG findings is associated with Complete heart block

Answer 6

RBBB

Question 7

ECG findings associated with myectomy vs alcohol septal ablation in HCM.

Answer 7

myectomy can result in LBBB

alcohol septal ablation-> RBBB

Question 8

Class I indication for pacemaker in patient with congenital CHB

Answer 8

Question 9

Mechanism of Heat block in inferior MI

Answer 9

• AV node ischemia
• increased vagal stimulation

Question 10

Pacemaker indication for “ictal bradycardia”

Answer 10

Question 11

Pacemaker indication for Carotid Sinus Hypersensitivity

Answer 11

Question 12

Pacemaker indication for Vasovagal Syncope

Answer 12

• not recommended

unless it is mixed

Question 13

Pacemaker Nomenclature

Answer 13

Question 14

Pacemaker mode selection for Sinus node dysfunction with intact AV conduction

Answer 14

DDD or DDI or AAI

Question 15

Pacemaker mode selection that is Asynchronous operation

Answer 15

VOO
DOO

• what happen if you place a magnet in PACEMAKER (not with ICD)

Question 16

What is Ventricular Refractory Period

Answer 16

Question 17

What is PVARP - Post-Ventricular Atrial Refractory Period

Answer 17

Question 18

What to adjust in Pacemaker Mediated Tachycardia?

Answer 18

adjust PVARP longer

PMT usually triggered by PVC, in DDD mode

Question 19

Atrial fibrillation during DDD

Answer 19

Mode switch back to DDIR - non tracking mode

Question 20

Type of pacemaker malfunction?

Answer 20

Question 20

Type of pacemaker malfunction?

Answer 20

Question 20

Type of pacemaker malfunction?

Answer 20

Question 21

Type of pacemaker malfunction?

Answer 21

Question 22

Type of pacemaker malfunction?

Answer 22

Question 23

Type of pacemaker malfunction?

Answer 23

Question 24

Clue/s of lead fracture in pacemaker interrogation

Answer 24

sudden rise/high impedance normal impedance - 300-1200

Question 25

Clue/s of insulation breach in pacemaker interrogation

Answer 25

drop of lead impedance normal impedance - 300-1200

Question 26

Drugs that could increase pacing threshold

Answer 26

- flecainide -amiodarone ***while epinephrine can decrease threshold

Question 27

Secondary prevention for Ischemic heart Disease: indication for ICD

Answer 27

Question 28

Primary Prevention for ICD

Answer 28

Question 29

Secondary prevention for NON-Ischemic heart Disease: indication for ICD

Answer 29

Question 30

Primary Prevention for ICD

Answer 30

Question 31

ICD indication in HCM

Answer 31

Question 32

Expected outcome in patient with CRT

Answer 32

- ≥ 15% decrease in ESV - Increase LVEF

Question 33

CRT indication

Answer 33

Question 34

Top 10 take-home messages from 2023 Physiologic Pacing Guidelines

Answer 34

Question 35

Top 10 take-home messages from 2023 Physiologic Pacing Guidelines

Answer 35

Question 35

CRT indication (Class I)

Answer 35

sinus rhythm, EF ≤35%, LBBB ≥150ms, NYHA Class II-IV ***if Afib, will be class IIa