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Paed Device manuals > General Knowledge > Flashcards

General Knowledge Flashcards

1
Q

Stages of HF diagnosis after ECHO

A

EF
LV or Atria- ?dilated
Hypertrophic
Hypokinesis
Valves
RV

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2
Q

HF - BB

A

Dilate vessels, reduce O2 consumption and workload

Carvedilol
Bisoprolol

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3
Q

HF - ACE

A

Rampiril
Lizinopril
Inatopril

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4
Q

HF - ARBs

A

Candesartan
Losartan
Alsartan

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5
Q

Propafenone

A

Lower HR
For symptomatic SVT without structural disease

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6
Q

In what arrhythmias can Flecainide be used? What are its effects?

A

Cardio version of AF without structural disease
AVNRT, AVRT, PAF
Persistent VT or frequent PVCs with symptoms

Reduces conduction throughout the whole heart

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7
Q

Flecainde and propafenone ECG effects

A

QRS and QT prolongation

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8
Q

Amiodarone

A

Most potent drug
For Serious VT/SVT = WPW, flutter, AF to sinus rhythm
Deceases automaticity

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9
Q

Amiodarone effect on ECG

A

Prolongs QT

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10
Q

Sotalol

A

For VT/SVTs, rhythm control in SVTs after return to sinus rhythm
Decreases automaticity

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11
Q

Sotalol effect on ECG

A

Prolong QT

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12
Q

BB

A

Reduces catechlomines
Reduced inotropic (contractility) = reduced O2 consumtion
Reduced chronotropy (HR) = prolonged diastole thus increased myocardial perfusion
Decreased automaticity = decreased sinus rate

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13
Q

BB on ECG

A

Prolonged AV interval
QT shortens

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14
Q

ChadVASC score components

A

 Age: <65 (0 points), 65–74 (1 point), ≥75 (2 points)
 Gender: male (0 points), female (1 point)
 Congestive heart failure (1 point)
 Hypertension (1 point)
 Stroke, transient ischaemic attack (TIA) or thromboembolism (2 points)
 Vascular disease (1 point)
 Diabetes mellitus (1 point)

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15
Q

CHADVASC score interpretation

A

Scores of:
0 indicates low risk
1 indicates low-to-medium risk
2 or more indicates moderate-to-high risk

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16
Q

Split cathodal pacing causes

A

Increase in stimulation threshold and decrease in impedance

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17
Q

Common inappropriate causes of MS

A

FFRWOS
Atrial lead sensing v signals

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18
Q

Structures not surrounding the ostium of the CS

A

Crusts terminalis

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19
Q

PMT algorithm occurs during Sinus tachycardia why?

A

Because increase in atrial rate means p waves fall into PVARP
Increasing MTR resolves this

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20
Q

S2 is

A

First premature stimulus

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21
Q

Smaller electrodes cause

A

Increased lead impedance

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22
Q

Systolic BP is equivalent to

A

After load

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23
Q

Dispensibility or pressure x volume means

A

Compliance

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24
Q

Isovolumetric contraction is

A

Time from mitral valve closure to Ao valve opening

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25
Q

By what % does stroke volume increase during exercise

A

50%

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26
Q

DBS (drawn brazed) involves what metals

A

A combination of silver + nickel alloy conductor materiel

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27
Q

However a small pacing cathode allows for what?

A

Improved stimulation threshold

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28
Q

What procedures should be performed in highly symptomatic PAF

A

Cath and TOE

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29
Q

What drug reduces morbidity in MI

A

BB

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30
Q

AVB + VT/VF is seen in what neuromuscular disease

A

Chages disease

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31
Q

Normal INR ranges

A

2-3

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32
Q

What drug classes cause risk if torsades?

A

1A, 1C and III
erythromycin, azythromycin and tricyclic antidepressants

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33
Q

Types of ATP/BF termination

A

Type 1 - VF/successful 1 ATP to sinus rhythm
Type 2 - VF/unsuccessful 1st ATP with eventual spontaneous termination

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34
Q

Treatment of malignant vasovagal syncope

A

Metroprolol
BB

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35
Q

Long QT is related to what neuromuscular diseases

A

Anderson, Romano-Wad, Jerville syndromes

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36
Q

Normal HV intervals are

A

35 - 50ms

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37
Q

Thyroxitoxics manifests as

A

Polymorphic VT

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38
Q

What drug does not trigger torsades?

A

Adenosine

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39
Q

RV dysplasia vs brugada

A

RV dysplasia = MVT
Brugada = PVT

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40
Q

Most common cause of failure to output is

A

Oversensing

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41
Q

After acute MI should pacing be performed or not

A

Temporary pacing due to risk of CHB

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42
Q

Diastolic dysfunction

A

Impaired early diastolic relaxation due to ischemia = increased stiffness and LV hypertrophy

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43
Q

Left sided symptoms

A

Dyspnea on exertion
Tachycardia
Cough

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44
Q

Right sided symptoms

A

Nausea
Bloating
Swelling

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45
Q

True or functional loss of sensing caused by

A

Pseudofusion, URB, oversensing resulting in undersensing

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46
Q

True or functional loss of capture is caused by

A

Isoelectric depolarisation, undersensing intrinsic beats, lead dislodgement

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47
Q

What causes longer AA or VA intervals

A

Make/break conductor fracture. FF sensing, PMT algorithm

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48
Q

Failure to pace is caused by

A

Battery failure, after potential oversensing, unipolar to functional bipolar

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49
Q

Why does atrial undersensing cause inappropriate ICD discharge?

A

Caused by more V than A = classification as VT causing detection

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50
Q

AV desynchronisation/RNRVAS involves

A

Retrograde conduction, functional non sensing and functional non capture

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51
Q

RV on EGM and LV on AGM shows what?

A

Determines the amount of separation between the LV and RV leads

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52
Q

Class I removal indications for infection

A

Endocarditis
Sepsis
Pocket abscess
Skin adherence
Occult gram post Bacteremia

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53
Q

Class I lead removal indications for thrombus & stenosis

A

Thrombus on lead
SVC or subclavian occlusion
Stent deployed in vein with lead

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54
Q

Class I indications for removal of functional or non-functional

A

Life threatening arrhythmias caused by leads
Immediate threat of leads left in place
Leads interfere with other leads

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55
Q

How does insulation break causes LOC

A

Current drain from lead means 2x as much current is required to capture the same tissue

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56
Q

Equation for capacitor energy

A

E = 1/2C x V2

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57
Q

Most common cause of safety pacing

A

VEs

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58
Q

Define threshold slope

A

Amount of energy required to initiate or trigger sensor activity

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59
Q

Define sensor slope

A

Level of response of the device to sensor signals

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60
Q

Sleep apnea programmable solution

A

Rate drop response
Sudden Brady response

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61
Q

Treatment of AF

A

Diltiazem in AF = effective rate control

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62
Q

Contraindication for MRI in non MRI CIEDs

A

Having an abandoned lead
Lead fracture
Epicardial

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63
Q

What depletes battery most quickly

A

Increased current drain

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64
Q

2:1 HB seen in during recovery following surgery. What is the next step?

A

Implant permanent pacemaker

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65
Q

Determine the Transvenous ICD shock vectors

A

B - tip
A - can
X - SVC or azygous cool

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66
Q

Identity common analgesic DRUGS

A

Codeine.
Fentanyl.
Hydrocodone.
Meperidine.
Methadone.
Naloxone or naltrexone.
Oxycodone.

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67
Q

Reversal drugs for benzodiazepines and opiates

A

Opiates - Naxalone
Benzodiazepines - flumazenil

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68
Q

Epicardial pacing is recommended for:

A

Patients <15kg
- Patients with intracardiac shunt lesions
- Limited access to atrium or ventricles (e.g. patients with single ventricular physiology post fontan palliation)
- Prosthetic tricuspid valves

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69
Q

Disadvantages of epicardial pacing

A

Disadvantages
Associated with higher chronic stimulation thresholds, higher lead failures and fractures, early depletion of battery life.

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70
Q

Advantages of epicardial pacing

A

Preserves venous access for future use

Steriod eluting epicardial leads are preferred as they prevent threshold increase in the long term.

LV apical pacing is the best site for epicardial leads in children

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71
Q

Which pouch is not know for reduced infection rates?

A

Parsonnet

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72
Q

What parameter you change for this patient

A

Sensitivity - sensed AV delay should be 90ms. The Vp occurs much shorter than that thus it can be assumed that A undersensing has occurred which did not start and AVI so Vp after LRL times out occurs

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73
Q

Factors that can cause high thresholds, small p or R waves and higher lead impedances (and sometime LOC)

A

Macro dislodgement
Micro dislodgement
Lead fibrosis
Lead insulation or conductor failure

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74
Q

What can be seen in this EGM trace?

A

AVNRT

AVRT has a longer VA interval

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75
Q

In a patient with a HIS bundle > 100ms what would be the next suitable approach

A

Implant pacemaker - class IIa indication

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76
Q

For symptomatic SVT

A

Ep study should be performed

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77
Q

Which of the following is the most common clinically relevant interaction with an MRO and a non-MRI conditional device?

A

Power reset

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78
Q

AHA guidelines for AF treatment

A

1st line - Beta blockers
flecainide, propafenone, and sotalol
Alternatives: Amiodarone and dofetilide

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79
Q
  1. A 67yo male with Class II HF, EF 32% and QRS 140ms is implanted with a CRT-D. Remote FU detects some bouts of PAF at the 9 month period. The patient is then seen in clinic and diagnostics indicate the AF burden is 8%. He is asymptomatic. Which is the most appropriate for this patient?
    a) Continue to monitor the patient before intervention
    b) Start on aspirin
    c) Start on sotalol
    d) Start on dabigatran or rivaroxaban and consider turning on atrial overdrive pacing algorithm
A

d) Start on dabigatran or rivaroxaban and consider turning on atrial overdrive pacing algorithm

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80
Q

Subclavian crush affects impedance how?

A

Higher impedance

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81
Q

upper limit of vulnerability

A

The weakest or above which VF will NOT induce

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82
Q

Evoked response

A

Electrical event (from depolarisation) caused by output pulse

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83
Q

Algorithms for trouble shooting lead noise that diagnose lead noises caused by a) fracture of the pacing or sensing conductors, b) an insulator rupture, or c) an insufficient tightening or a faulty insertion of the lead connector in its receptacle also for over-sensing of P and T waves, double counting of the R wave = elimination of inappropriate therapies

A

Noise revision
Post sense delay decay

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84
Q

How does noise discrimination work?

A

discordance between the 2 channels be detected, presence of short cycles on the bipolar channel (near field) but not on absence of discrimination channel ( far field)

True v arrhythmia = both channels are concordant - short cycles are detected on the bipolar channel and discrimination channel

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85
Q

When can post pacing v blanking be changed

A

During the over sensing of post pacing T waves

86
Q

Determine patient Vs device related causes of PMT

A

Patient-related causes include PVCs, PACs, the accessory pathway, and an interatrial conduction de- lay.

Device-related causes include unusually short programmed PVARP, long programmed AV interval, atrial undersensing, and atrial failure to capture.

87
Q

Effect of epicardial temporary pacing post surgery that may or may not be working

A

Additional pacemaker artifacts
Competition between permanent pacing and temporary pacing
Inhibitor if permanent pacemaker by temporary pacing

88
Q

Define amylodosis

A

serious conditions caused by a build-up of an abnormal protein called amyloid in organs and tissues throughout the body

89
Q

Explain atrial preference pacing

A

increasing the atrial pacing rate = suppression of a spontaneous atrial rhythm and prevent supraventricular tachyarrhythmias.

APP responds to changes in the atrial rate by accelerating the pacing rate until it reaches a steady paced rhythm that is slightly faster than the intrinsic rate

90
Q

Define fallback mode

A

designed to limit tracking of atrial arrhythmias by automatically mode switching to a non-tracking mode when programmed ATR criteria are met

91
Q

Steps to troubleshooting oversensing on an ICD lead

A

Adjust blanking or refractory periods e.g. p wave oversensing adjust PAVB
Reduce sensitivity
Replace lead

92
Q

Differential diagnosis for this trace includes

A

RV lead dislodgement to tricuspid annulus or right atrium near valve

RV lead implant in CS

Lead to lead interaction with A lead hitting V lead during valve motion

RV distal coil crossing tricuspid valve this sensing atrial activity im inter grated bipolar

RV insulation break near A lead = atrial sensing

93
Q

What is occurring in the EGM below?

A

FFRWOS
Although the EGM pattern shows an RNRVAS pattern with SIR (RR) activated after MS the atrial signals continue with double counting pattern suggesting some oversensing

94
Q

Suggested programming parameters for PAF

A

DDIR 65 base rate/ 175ms AVI/ 65bpm atrial tracking limit/ 110 sensor rate limit

95
Q

Identify the first and second most common causes of PMT

A
  1. PVC
  2. Loss of atrial capture
    altered AV synchrony = allows retrograde conduction
96
Q

Applying a magnet during a PMT shows what?

A

Differential diagnosis of PMT is atrial tachycardia or sinus tachycardia

If Application of a magnet during the taxhyarrhythmia fails to terminate the tachycardia = not PMT

97
Q

When is pseudo pseudo fusion most commonly seen?

A

DVI mode
Committed atrial capture

Defined as when an stimulus artefact from one chamber is superimposed on a deflection arising from another chamber

98
Q

What is the clinical relevance of finding fusion or pseudo fusion

A

Clear fusion confirms capture

pseudo fusion or questionable fusion:
- failure to sense intrinsic
- failed capture (increase pacing rate to assess morphology)

99
Q

What does this ECG of a DDD device show?

A

RR intervals occur at 80bpm but pacing spikes occur at 60bpm regardless of intrinsic = intermittent undersensing

Intrinsic QRS sensed
VA interval occurs and times out
Ap delivered and PAVB starts
Intrinsic QRS is blanked and Vp is delivered on T wave

Ap and Vs occurring at the same time = pseudo pseudo fusion

100
Q

In this AAI pacemaker programmed at 60bpm what is occurring in the EGM

A

Atrial undersensing and non capture due to lead dislodgement

Think it’s not sensing anything; hint pseudo fusion occurs
Do spike cause depolarisation?

101
Q

Why is atrial undersensing in ICDs dangerous?

A

Atrial undersensing causes V > A = counters towards detection

102
Q

What is the detection criteria for treatment of atrial tachyarrhyrthmias?

A

To meet criteria for atrial tachyarrhythmia -> A > V (more A than V)

In AAI no V lead so no V sensing to compare atrial events with = detection never met

103
Q

What occurs with battery nearing ERI?

A

Sudden rate drop (magnet rate)
change to simpler mode
Sudden increase of pacing outputs

104
Q

Causes of T wave oversensing include?

A

Based on near field EGM:

Small sensed R wave to T wave ratio (decay delay curves depend on the size of the R wave = difficult to reprogram with small R wave -> lead revision)

R wave larger than T wave amplitude

During Vp (pacing rate may be slowed = bradycardia not inappropriate shocks)

105
Q

Reprogrammable Trouble shooting options for T wave oversensing caused by small R wave

A
  1. Lead revision
  2. Reduce sensitivity
  3. Adjust delay decay
106
Q

Ventricular lead oversensing signals from the atrial channel suggests what?

A

Lead dislodgement

107
Q

Reasons for paced rates below LRL include?

A

Oversensing = underpacing
Open circuit
Battery depletion
Auto capture algorithms
PVARP extension for PVCs
Rest/sleep mode
Hysteresis

108
Q

What is one hint that auto capture threshold tests are occurring?

A

They occur with back up safety pulses when capture fails

109
Q

What is happening in this trace?

A

Pacing artefact at beginning of QRS, then pacing spike in T wave = Ap causes ventricular depolarisation with AVI timing out and Vp being delivered on T wave.

110
Q

What can cause failure to output?

A

Header connector pins not in fully
Can failure

Magnet mode can be used to rule out failure to output I.e. no pacing artefact and intrinsic morphology

111
Q

Define competitive atrial pacing

A

Triggering atrial arrhythmia by Ap on atriums vulnerable period

112
Q

Can the LRL be violated in V based or A based timing

A

Violated in V based timing
Not violated in A based timing (Vs in VAI)

113
Q

A based timing is the main timing cycle used within Hybrid based timing. When is V based timing with hybrid timing?

A

When loss of AV synchrony occurs it switches to V based timing (Vp)

114
Q

Pacing above LRL

A

RR
MS
Sudden rate drop response
Magnet mode
V auto capture

115
Q

Pacing below LRL

A

Hysteresis
Sleep or rest rate
Atrial based timing

116
Q

AVI longer than programmed

A

AV hysteresis
Algorithms for intrinsic conduction
URB

117
Q

The atrial escape interval is violated during what timing cycles?

A

Impossible to violate during A based timing

Can be violated during V based timing

118
Q

Things to improve CRT response

A

Increase LRL
Enable ventricular sense response
Aggressive medical therapy
AF ablation
AVN ablation

119
Q

Define virtual electrode

A

regions of cardiac tissue for which the membrane. potential is electrotonically altered by the stimulus current.

120
Q

Define anodal stimulation

A

Anodal stimulation - capture at the pacing anode instead of cathode.

more common at higher pacing outputs. If anodal stimulation occurs when a CRT device is programmed LV tip to RV coil, the RV is unintentionally captured instead of the LV.

121
Q

How can pectoral myopotentials cause inappropriate detection?

A

By distorting Far field EGM during SVT leading to morphology mismatch e.g. sinus tachycardia during exercise

122
Q

Explain v based timing in relation to rate

A

If there is intact AV conduction; after an Ap, the AR interval would be shorter than the programmed AVI = slightly faster paced rate

123
Q

Explain the different between V based timing and A based timing in relations to rate

A

V based timing - AVI interrupted with instrinsic beat = short AVI than programmed -> slightly faster paced rate (intrinsic earlier = VA timer starts earlier
So next AP occurs at a slightly faster rate)

A based timing - AVI interrupted with intrinsic beat does not alter AA timing = rate stays at LRL I.e. AAI (because it’s AA timer rather than VA that is reset)

124
Q

Explain modified atrial based timing

A

Vp = VAI from V to next V event (V based timing)
If intrinsic occurs and interrupts the AVI, it switches to A based timing to ensure accurate pacing rates during intrinsic conduction

125
Q

Define fall back response

A

During mode switch for AT
Rather than V rate falling abruptly to LRL from the high rates before MS, it allows gradual fall back to LRL to minimise symptoms

126
Q

Define rate smoothing

A

Introduces pacing impulse earlier than expected to minimise cycle length variation following PVC

127
Q

RID + Vs RID- markers

A

RID +.- rhythm ID morphology match
RID - - rhythm ID morphology mismatch

128
Q

Troubleshooting options for air in header

A

Entrapped air usually disappears after 1-2 days but trouble shooting can be:

Programme to DOO with therapies off and observe for 24hrs

129
Q

What noise source does the EGM below display?

A

Noise due to loose set screw
Occurred during provocative manoeuvres

130
Q

Potential causes of R wave diminution

A

Acute - Lead dislodgement, perforation, loose set screw

Chronic - lead maturation/fibrosis, structural lead defect

131
Q

In what setting does electrical power rest occur

A

High voltage or magnetic fields
Expect to see continuous electrical signals on ff and nf and ask exposure history (figure out what the patient was doing at that time)

Severe reset = therapies turned off

132
Q

Frequent arrhythmia in the immediate period following lead placement can result from what?

A

Cardiac perforation
Mechanical ectopy from the lead
Inappropriate programme of the device
Presence of endocardia or epicardial leads

133
Q

Identify one characteristic about DVI mode

A

Atrial stimuli May occur following the onset of ventricular depolarisation

134
Q

Addition of an SVC coil to an ICD lead will do what to an ICD waveform using a fixed tilt

A

Shorten the waveform

Adding more metal creates a parallel circuit this reduces the total amount of resistance

This if same voltage and tilt was applied to single Vs dual coil system due to less resistance the % tilt is reached at a much quicker rate.

135
Q

Define HV interval

A

The HV interval represents conduction time from the proximal His bundle to the ventricular myocardium

Normal 40-60ms which means after Vp activation should only take 40ms

136
Q

Define AH interval

A

AH interval represents conduction time from the low-right atrium at the interatrial septum through the AV node to the His bundle.

137
Q

What is occurring in the EGM below and identify it’s trouble shooting

A

P wave oversensing from the ventricular lead during His bundle pacing

This is because the His lead is commonly located in the atrium when pacing = small R waves and p wave over sensing

Increase PAVB, change lead polarity or decrease V sensitivity

138
Q

What is occurring in the EGM below?

A

His potential oversensing

Adjust sensitivity or sensing polarity for better ratio between P and R waves

139
Q

What to consider to overcome BB delay

A

Increase output
Move His bundle lead distally
Virtual electrode polarisation

140
Q

Selective HBP

A

Pure HB pacing -> stimulus to Vp is = intrinsic HV interval so paced QRS is the same as intrinsic QRS = BBB normalisation

Vp ventricular activation overrides purkinje system

Assume catheter is within the HBP

QRS narrows at higher outputs due to fusion between RV and HBP

141
Q

Nom selective HBP

A

Capture of both local myocardium and conductive tissue = Stim - V interval < HV interval

At Lower pacing output changes are seen in QRS due to loss of HB capture

QRS widens during lower outputs due to loss of HBP capture

142
Q

Shorter AVI than programmed

A

NCAP
V safety pacing
MVP
dynamic AV
Negative AV
Auto thresholds

143
Q

define and explain LV protection period

A

Left ventricular protection period

Prevents LVp in LV vulnerable period After LVs I.e. when LV PVC occurs

144
Q

Define load and how it relates to the circuit of a device

A

Impedance applied to a circuit

Small load = small resistance I.E. constant current

Large load = large resistance I.e. constant voltage

145
Q

Identify signals that the VRP is meant to blank

A

T wave
Paced QRS
Own impulse
Excessive afterpotential

146
Q

Why is Vsp stimulus delivered in a shorter time than normal physiologic AV delay

A

Pace within refractory period = no pace in vulnerable period

147
Q

What is the effect of programming a PVARP shorter than the VRP

A

Increased FFRWOS of the end portion of Vp QRS

148
Q

Programmable parameters that can be changed to test for PMT

A

Low A output
Short PVARP
Highest A sensitivity

149
Q

Arrhythmia termination with Vs suggests what?

A

SVT

150
Q

Safety pacing can result from…?

A

Normal AV conduction with atrial undersensing

151
Q

Pacing a patient after tricuspid annuloplasty allows for which type of pacemaker?

A

Endocardia lead can be placed across the tricuspid valve

152
Q

What is the next step if unable to extract lead via simple traction r active fixation mechanism?

A

Cap the lead and leave it in situ

153
Q

Incremental options for extraction of helix does not extract during lead extraction

A

Stylet down other leads for stability
Active fixation mechanism and traction
Lead rotated and manual traction
Locking stylet to aid traction
mechanical sheaths or laser sheaths (passes over the lead, surrounding it and freeing it from the body by disrupting scar tissue as it is advanced toward the heart)
Snare
Cap and leave in situ

rate of major complications was 1.6% to 2.0% - tearing the surrounding blood vessel or perforating = bleeding around the heart

154
Q

Feature of activity sensor pacemaker (pressure)

A

Less responsive to ascending than descending stairs

155
Q

Most common clinical problem with AAI pacing is

A

Atrial undersensing

156
Q

Crosstalk does not occur in what mode

A

Committed DVI

157
Q

What has an effect of interrupting atrial flutter?

A

Rapid atrial pacing

158
Q

Explain why acute MI with bilateral BBB and no AVB would receive temporary pacing

A

MI = ischemia of conduction system fascicles -> BBB or AVB thus risk of progression to AVB is high

Temporary pacing provides hemodynamic support following acute MI = cardiovascular management prior to myocardial necrosis

159
Q

In AF with fast Ventricular conduction, what would be the usefulness of a short refractory period?

A

A short refractory period would account for rapidly conduction ventricular contraction (all As so no pacing)

160
Q

High impedance/resistance lead =

A

Low current drain and long battery longevity

161
Q

What is the disadvantage of VA conduction

A

Loss of atrial kick = decrease stroke volume -> CO
increase in atrial pressure causing acute atrial stretch and reverse flow = AF
Atrial contraction against close AV valves

162
Q

If sensor indicated rate is higher than upper tracking rate what would you expect to happen

A

AV sequential pacing - ApVp

A rate faster than upper sensor would lead to URB

163
Q

Sotalol causes bradycardia in the context of PAF with bifascicular block and VF with symptoms of syncope. What should be done next?

A

Discontinue Sotalol and implant PPM

Pacemaker indication in the context of CHB in Bifascicular block

Sotalol can cause pause dependant prolongation if QT = vt
Syncope caused by sotalol

Any patient with proarrhythmia due to anti arrhythmic should be discontinued

No ICD in AF

164
Q

RV apical pacing would show what axis on the inferior leads

A

Negative in inferior leads

165
Q

RVOT pacing would show what axis in the inferior leads

A

Positive

166
Q

1 or more SCD risk factors for HCM is what class indication?

A

IIa

167
Q

What RVOTO gradient in HCM suggests immediate risk of SCD dispute RVOT being a low predictor

A

> 30mmHg

168
Q

What indications suggest implant one bibentricular ICD

A

Low EF

169
Q

What is the mechanism behind programming high pacing rates following AVN ablation for the first 3 months post procedure?

A

Rapid change in HR from AF to slow Brady pacing can allow Brady induced VT (torsades).

170
Q

What is the effect of Vp on mitral regurgitation

A

Increase MR

171
Q

Why is dual chamber pacing important during sinus pauses such as that occurring in malignant syncope?

A

Maintain AV synchrony during long pauses

172
Q

Identify examples of benzos

A

Diazepam
Clonazepam
Lorazepam
Alprazolam

Anything with am

173
Q

Identify examples of opiates

A

Tramadol.
Methadone.
Pethidine.
Oxycodone.
Fentanyl

174
Q

These signs suggest?
- low BP
- tachycardia
- distended JVP

A

Pericardial tamponade

175
Q

Poor bilateral breath sounds and no extra thoracic venous access site suggests?

A

Pneumothorax

176
Q

Dissection if the superior vena cava would present as?

A

Low BP
Tachycardia
JVD distension
Swelling of head and upper extremity veins

177
Q

Magnet application in CRTs inappropriate because…?

A

Stops biventricular pacing efficiently and could cause hemodynamic compromise as a result

178
Q

An application of a magnet in an ICD does what?

A

Deactivated detection and therapies

No asynchronous pacing

179
Q

Radiation on device means

A

Change device

180
Q

Tachycardia that persists despite intermittent lack of conduction to ventricle

A

AT

181
Q

Conductor failure causes

A

Oversensing
Increased impedance
Increased Pacing threshold
Failure to defibrillate due to current shunting

182
Q

Failure to generate energy for shock is caused by

A

Failure of pulse generator
Short circuit

183
Q

Insulation failure close to can will cause

A

Current arching leading to direct damage to can with transistor short and ICD system failure

184
Q

Failure to plug SVC port results in..?

A

Failure to deliver shock

185
Q

Reversal of leads in ICD header results in…

A

Reversal of shock polarity and unipolar sensing

186
Q

Troubleshooting for failed shocks includes

A

Reprogramming shock wave
Reposition lead
Add azygous/array lead

187
Q

Highest risk of hemotoma

A

Heparin

20% risk/ 5x the normal

188
Q

AF that is not detected, AF with fast ventricular conduction leading to pacing what is the troubleshooting mechanism

A

Shorten PVARP

189
Q

Explain Blanked flutter search

A

Blanked flutter search – Monitors for A–A intervals for 2:1 blanking of atrial events.
2:1 blanking detected = extends PVARP and the VA interval to uncover blanked AS events
If an A-A interval shorter than the detect rate interval is detected, 2:1 sensing of an atrial tachyarrhythmia is assumed. Otherwise, the pacemaker resumes monitoring for 2:1 sensing of atrial tachyarrhythmias in 90 seconds.

190
Q

Voltage stored on a capacitor is equal to what?

A

Initial shock voltage

191
Q

Cathodal shocks cause what wavefronts?

A

Anodal wave fronts that are expanding and proarrhythmic

Cathodal wavefronts are collapsing and self terminating

192
Q

Trouble shooting for Excessive safety pacing from VEs.

A

Shorter blanking period

193
Q

Define rate smoothing

A

Used to minimise variations in RR intervals/ regularise v rhythm
Atrial overdrive pacing just above the pacing rate

Ventricular rate stabilisation runs off PVCs

194
Q

Post pacing interval

A

Time required for last stim to reach circuit, travel around and return to pacing cite

195
Q

3 things that affect the ability of a device to sense an evoked response

A

Polarisation effect
Electrode- lead interface
Tip to ring space

196
Q

What is RV latency dependant on?

A

Rate and output

197
Q

Why is HIS bundle pacing inferior to conventional pacing

A

Long implant time
Higher risk of lead dislodgement
Steep learning curve
High thresholds
Not applicable to patients with BBB

198
Q

How does tissue fibrosis affect leads

A

Improves stability
Increases lead size thus increases current drain

199
Q

Equations related to power

A

P = I x V
E = P x T

All together is E = I x V x T

200
Q

Frequency to BPM calculation

A

1 hertz = 60 Bpm

201
Q

Generator erosion is considered as…

A

Indolent infection
Extract

202
Q

Troubleshooting for phrenic nerve stimulation

A

Lower outputs
Change electrode configuration
Reposition lead

203
Q

Factors not associated with lead extraction complications

A

High BMI
Prior open heart surgery

204
Q

Open loop

A

Accelerometer
Piezoelectric

205
Q

Partial open loop

A

Temperature
Respiratory rate

206
Q

Closed looo

A

CLS
Minute ventilation

207
Q

Source impedance

A

Voltage drop from IEGM origin to proximal lead

208
Q

Extended bipolar (lV tip to anode (ring or coil) results in…?

A

Anodal capture
Diaphragmatic myopotentials (on V channel)

Pectoral myopotentials are in unipolar configuration

209
Q

VT/VF zone happenings

A

Detection met
Charge starts
Re-confirmation (short cycles that fall into VT/VF zone e.g. 2/5) - occurs during charging because aborted charges = prolonged battery life.
Charge end
Shock delivery

210
Q

Determine characteristic of non-committed shock

A

First shocks are always non-commuted in ICDs
Shock not delivered at end of capacitor charge

211
Q

Why is not having too much slack in the form of a loop, important?

A
  1. To not cause a block in IVC
  2. To not cause TR from sitting on the Tricuspid annulus
  3. Risk of pulling back into RA
  4. Risk of slack falling into RVOT and causing a block there

Paed Device manuals (7 decks)

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