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Year 3 Cardiac physiology > CRM8: Permanent Pacing Implant > Flashcards

CRM8: Permanent Pacing Implant Flashcards

1
Q

List 3 bradycardia syndromes

A

Sinus node dysfunction
-Abnormality in sinus node impulse formation and propagation

Sick sinus syndrome
-Sinus bradycardia, sinus pause/arrest, AF

Atrioventricular block
-Partial or complete interruption of impulse from atria to ventricles

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2
Q

What symptoms indicate bradycardia syndromes?

A

-Syncope
-Dizziness/presyncope
-Dyspnoea
-Mental confusion
-Palpitations

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3
Q

What are the classes of recommendation?

A

Class I - recommended
Class IIa - should be considered
Class IIb - may be considered
Class 3 - not recommended

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4
Q

What are the levels of evidence?

A

A: Data from multiple RCTs/meta-analyses
B: Data from single RCT or large non-RCT
C: Consensus of opinion by experts and/or small studies

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5
Q

Class and evidence level for pacing in patients with permanent bradycardia

A
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6
Q

Class and evidence level for pacing in patients with intermittent bradycardia

A
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7
Q

Class and evidence for pacing in patients with BBB

A
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8
Q

Class and evidence for pacing in patients with undocumented reflex syncope

A
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9
Q

Class and evidence for pacing in patients with unexplained syncope

A
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10
Q

Types of bradycardias that can be paced

A
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11
Q

Who should you not put pacemaker in? (Class III)

A

-People with reversible causes of bradycardia

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12
Q

Mode selection in sinus node disease and AV block

A
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13
Q

In what conditions would you programme AAI?

A

-Chronotropic incompetence
-Sick sinus disease
-Normal AV node conduction
-Unlikely to develop an atrial arrhythmia

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14
Q

In what conditions would you programme VVI?

A

-No normal atrial rhythm
-Impaired AV conduction
-Slow/no ventricular rhythm
-Unable to have DDD due to vascular anatomy
-Ablate and pace for AF
-No AV synchrony - ventricular support

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15
Q

In what conditions would you programme DDD?

A

-Intact atria, conducting normally
-Intact or impaired AV conduction
-Slow or no ventricular rhythm
-Benefits from A-V synchrony
-Heart failure?? CRT-P
-Atrial dysrhythmias

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16
Q

Device, mode, class and level of evidence?

A

-DDD
-Programme AAIR for chronotropic incompetence
-Class I level B

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17
Q

Device, mode, class and level of evidence?

A

-VVIR
-Class I level B

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18
Q

Device, mode, class and level of evidence?

A

-DDD
-Class I level C

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19
Q

Device, mode, class and level of evidence?

A

-No permanent pacing
-Class 3
-Temporary pacing only if patient can’t cope

20
Q

Clinical history and pre-assessment in pacing

A

-Symptom and pathophysiology history
-Results from diagnostic tests
-Choice of pacing mode
-ECG?
-Informed consent

21
Q

Pre implant checklist

A

-Nil by mouth
-Venous access
-Antibiotic prophylaxis
-Skin prep
-Blood results - Hep/HIV/INR/Hb

22
Q

Patient safety and pre op

A

-MDT - sign in check list
-Vital signs - ECG/BP/Oximetry
-Defib/pacing/pericardial tap kit
-Is patient comfortable/warm?

23
Q

What are points of access for pacing procedure?

A

-Subclavian vein
-Axillary vein
-Cephalic vein

24
Q

Cephalic cut-down vs Subclavian puncture

A

Cephalic cut-down:
-Less complications
-Less trauma
-Depends on size of vein

Subclavian puncture:
-Puncture
-Split sheath
-Traumatic

25
Q

What are complications of subclavian puncture?

A

-Pneumothorax
-Haemothorax
-Air embolism

25
Q

What are the lead positions?

A

Left bundle pacing
-Narrow QRS
-Doesn’t cause remodelling

-Atrial lead in the right atrial appendage

26
Q

Why do we do AAI pace preference?

A

-Saves battery
-Prevents remodelling of ventricle

27
Q

Which patients might not have right atrial appendage?

A

-Bypass graft
-Use active fixation leads

28
Q

What do you measure on pacing system analyser (PSA) post implant?

A

-Sensing (P and R wave)
-Pacing threshold
-Lead impedance
-Lead stability
-Diaphragmatic and phrenic nerve stimulation
-Slew rate
-ST elevation (injury current)

29
Q

What does ST depression on injury current indicate?

A

-Perforation

30
Q

What is slew rate?

A

-How sharp the R wave is
-Maximum rate of change
-Higher = Better
-Expressed in Volts/second

31
Q

Values for pacing, sensing, slew rate and impedance

A
32
Q

Why do you get patient to cough?

A

-To test stability

33
Q

Why do you pace at 10 volts?

A

-To test for diaphragmatic twitching

34
Q

What do you check post implant?

A

-Confirm lead position
-Confirm appropriate function
-Confirm stimulation site
-Wound check, final tests, programming through device

35
Q

Complications of pacing implant

A

-Pneumothorax
-Haemothorax
-Air embolism
-Haematoma
-Cardiac perforation
-Pericardial effusion/tamponade
-Subclavian crush

36
Q

What complication is this?

A

Pneumothorax

37
Q

What complication is this?

A

Haemothorax
-blood is white

38
Q

What complication is this?

A

-Lead diplacement
-Lead break

39
Q

What complication is this?

A

Subclavian crush
-Lead break

40
Q

What complication is this?

A

Cardiac perforation

41
Q

What complication is this?

A

Haematoma

42
Q

What complication is this?

A

-Adherence
-Erosion
-Infection

43
Q

Why is the ventricular lead implanted first?

A

-Can pace through ventricular lead if AV node is disturbed

44
Q

How is permanent pacing different from temporary pacing?

A

Temporary:
-Can have alternative access site: femoral, internal jugular
-Used in TAVI
-Overdrive pacing to suppress an arrhythmia
-External

Year 3 Cardiac physiology (30 decks)

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