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Cardiology Technology > Implantable Cardiac Devices > Flashcards

Implantable Cardiac Devices Flashcards

1
Q

Who was responsible for the first external pacemaker?

A

Mark Lidwell, Albert Hyman

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2
Q

What was created in 1957, and by whom?

A

Earl E. Bakken produced the first battery-operated wearable pacemaker

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3
Q

What was introduced in the 2000s, and what benefit did it provide?

A

bi-ventricular pacing, paces both ventricles to go at the same time

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4
Q

What visual cue represents an unfired beat from the temporary pacemaker?

A

a vertical dotted line

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5
Q

What can happen if the sensitivity threshold on a temporary pacemaker is set too low?

A

ventricular fibrillation

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6
Q

How do you know where to set sensitivity?

A

half of the

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7
Q

What does VVI represent?

A

The ventricle is being paced, the ventricle is being sensed, the ventricular signal from the pacemaker is being inhibited.

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8
Q

What does VAT represent?

A

The ventricle is being paced, the atria is being sensed, the (?) signal from the pacemaker is being triggered.

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9
Q

What does DVI represent?

A

Both the atria and ventricles are being paced, the ventricle is being sensed, the ventricular signal from the pacemaker is being inhibited.

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10
Q

What are some benefits of choosing a temporary transvenous pacemaker over a transcutaneous pacemaker?

A

more comfortable, will move around less (reduced likelihood of dislodging)

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11
Q

What are the three main purposes of a permanent pacemaker?

A
  • restore rhythm/function
  • improve QoL
  • less time in hospital
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12
Q

What seven problems could a permanent pacemaker cause?

A
  • systemic infection
  • perforation
  • tamponade
  • mess with MRIs
  • vascular occlusion
  • cardiomyopathy cause by the pacemaker
  • lead revision/extraction/device/replacement
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13
Q

Which part of the unipolar-lead pacemaker is the anode?

A

the pulse generator

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14
Q

How can you distinguish a unipolar-lead pacemaker from a bipolar-lead pacemaker?

A

bigger pacemaker spikes

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15
Q

Where is the anode located in the bipolar lead pacemaker?

A

ring electrode

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16
Q

What type of fixation involves screwing?

A

active

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17
Q

What problems do using the subclavian vein in the transvenous insertion procedure have?

A

sharp angle within vein can compress and damage lead

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18
Q

What does voltage represent?

A

the strength/amplitude of the pacing pulse

19
Q

What does current represent?

A

how fast the charge goes through the circuit

20
Q

What are the three main sources of resistance/impedance?

A
  • the wire
  • the tip of the pacemaking wires
  • the cluster of ions where the cathode of the pacemaker meets the tissue of the heart
21
Q

What is a good range for impedance values to stay in ?

A

300 ohms - 3000 ohms

22
Q

Which electrical value is not directly controllable for a pacemaker?

A

current

23
Q

What is Ohm’s law?

A

I = V x R

24
Q

What will the ECG of a person who has a dual-chamber sensing pacemaker usually look like?

A

an ECG with NSR

25
Q

What is the purpose of the post-ventricular atrial refractory period?

A

prevent atria from responding erroneously (e.g. PACs, retrograde P-waves. far-field ventricular signals)

26
Q

What problems can come up with VDD pacing?

A

If the atrial rate falls below the LRL programmed in, AV synchrony will be lost, which can drain the battery faster.

27
Q

What can happen in DDI mode?

A

If the atrial rate becomes higher than the LRL, while the pacemaker is forcing the ventricles to beat at the LRL-set pace, so atria and ventricles stop working in tandem.

28
Q

What is DDI mode good for?

A

atrial tachyarrhythmias (e.g.) aFib, DDI mode won’t let the ventricles try to keep up with an extremely high atrial rate

29
Q

How does the single chamber pacemaker decide how to act on the intrinsic rhythm?

A

if intrinsic rhythm>LRL–> pacemaker inhibited

if intrinsic rhythm

30
Q

How is VA calculated?

A

cycle length (60,000/HR) - AV delay length

31
Q

Why is cross talk a problem?

A

If the atria are being sensed when the ventricles are supposed to be sensed, the pacemaker will inhibit ventricular activity, even when it is needed.

32
Q

How is cross-talk prevented?

A

blanking periods

33
Q

What is the total atrial refractory period?

A

AV delay + PVARP

The amount of time elapsed after impulse travels to AV node, and then the ventricles are allowed to repolarize

34
Q

How would loss of capture present on the ECG?

A

see spikes with no depolarization waves with it

35
Q

List examples of AV/refractory period-based pseudomalfunctions.

A
  • ventricular safety pacing
  • managed ventricular pacing
  • blanking
  • rate-adaptive AV delay
  • auto PVARP
  • PVC response
  • noncompetitive atrial pacing
  • ventricular sense response pacing
36
Q

How would atrial oversensing present on the marker channel of a paced ECG?

A

The marker channel will have AS markers but the ECG will have no p-waves in the same area.

37
Q

Normal range of impedance values?

A

200-2000 ohms

38
Q

How is lower rate interval calculated?

A

60,000/bpm

39
Q

What does “slew rate” mean?

A

Slew rate represents how much the voltage changes over a period of time

40
Q

What are the 3 components of the implantable pulse generator?

A
  1. battery
  2. connectors
  3. circuitry
41
Q

What does the first column of the universal code represent?

A

chamber that is being paced

42
Q

What are the 4 main indications for a pacemaker?

A
  1. symptomatic bradycardia
  2. sick sinus syndrome
  3. CHB
  4. chronotropic incompetence
43
Q

What 4 steps are part pf the pacemaker interrogation process?

A
  1. check lead integrity
  2. troubleshoot
  3. check device usage
  4. check battery life

Cardiology Technology (20 decks)

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