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MICRA TPS Flashcards

1
Q

Is the Micra TPS MRI compatible?

A

yes, for 1.5T and 3T full body MRIs

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2
Q

What is the longevity (battery life) of the Micra TPS?

A

approximately 12 years

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3
Q

What is the minimum acceptable battery voltage require at implant of a Micra TPS?

A

at least 3.0 mV

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4
Q

What are the steps to the pre-op pre-program of the Micra TPS?

A
  • interrogate to ensure battery voltage is at least 3.0mV
  • switch mode to VVI
  • set the date/time
  • program pacing values
  • switch to Device Off mode before implanting
  • click on end session
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5
Q

What needs to be done to the introducer of a Micra TPS prior to use?

A

wet with NS to activate the hydrophilic coating

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6
Q

How many tines are required to be engaged or in position prior to conducting a pull and hold test of a Micra TPS?

A

at least 2 tines need to be engaged

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7
Q

What is the recommended R-wave amplitude for a Micra TPS at implant?

A

5mV ≤

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8
Q

What is the recommended impedance for a Micra TPS at implant?

A

400 - 1500 ohms

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9
Q

What is the recommended threshold for a Micra TPS at implant?

A

< 1.0 V

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10
Q

What mode is set when using a Micra TPS?

A

VVI

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11
Q

What are the 2 methods for conducting a threshold test on a Micra TPS?

A
  • Capture Management (CM) (automated process)

- Amplitude decrement test (manual)

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12
Q

What is the first step in reposition a Micra TPS if unacceptable values result?

A

turn the device off

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13
Q

What solution is used to flush the delivery system of a Micra TPS prior to removing the tether (strings)?

A

heparinized saline to remove any formed blood clots

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14
Q

What should be done if resistance if felt when confirming free movement of the tether prior removal following deployment of a Micra TPS?

A

flush the delivery system with heparinized saline

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15
Q

What technique is used when inserted/placing a Micra TPS?

A
  • Seldinger Technique

- use of a guidewire and dilation cannula to place a catheter (same used for central line placement)

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16
Q

What feature adjusts the patient’s rate response to ensure that it remains appropriate for the full range of patient activities?

A

Rate Profile Optimization (RPO)

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17
Q

What is does the Rate Profile Optimization (RPO) feature do when programmed on a Micra TPS?

A

automatically adjusts the patient’s rate response to ensure that it remains appropriate for the full range of patient activities

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18
Q

How does the accelerometer in the Micra TPS tell the difference between the normal resting heart motion and the higher levels of motion that occur during exercise?

A
  • Lower Rate Setpoint feature sets a unique baseline to differentiate normal heart motion at rest versus that occurring with increased activity
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19
Q

What type of accelerometer is contained in the Micra TPS and why?

A
  • a 3 axis accelerometer compared to a single axis in traditional IPG
  • to account for the different angle positions the device may be in at implant
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20
Q

When is the Activity Vector Test (AVT) performed after a Micra implant?

A
  • prior to discharge after placement

- when there is concern about adequate rate response

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21
Q

The Micra TPS should be in what mode when performing an Activity Vector Test?

A

VVIR

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22
Q

What are the main purposes of the Activity Vector Test?

A
  • to set the rate response setpoints

- to determine the activity vector (1 or 3) where rate response performs the best

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23
Q

What should the lower rate setpoint be set to when manually programming setpoints on a Micra TPS following an Activity Vector Test?

A

set LR to 2 counts above the highest peak counts while at rest

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24
Q

What should the activities of daily living (ADL) setpoint be set to when performing manual programming on a Micra TPS following an Activity Vector Test?

A

set ADL setpoint to the value of the highest peaks while walking

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25
Q

What equation is used to manually program the upper rate setpoint on a Micra TPS following an Activity Vector Test?

A

UR = 1.5x (ADL setpoint - LR setpoint) + ADL

26
Q

What are the inner and outer diameters for the MICRA introducer?

A
  • inner = 23FR

- outer = 27FR

27
Q

How long is the MICRA introducer?

A

56cm in length

28
Q

What type and size of guidewire should be used to when inserting the MICRA introducer?

A

a superstiff 0.035mm guidewire

29
Q

What should be done if resistance is felt when confirming free movement of the tether after MICRA deployment?

A

flush the delivery system

30
Q

How often does capture management conduct threshold search for the Micra?

A

a pacing threshold search is done everyday and looks for an evoke response

31
Q

What is the threshold safety margin during the Acute phase (first 112 days) with a Micra?

A

the highest pacing threshold in the past 2 weeks + 1.5V

32
Q

What is the threshold safety margin during the Chronic phase with a Micra?

A

the highest pacing threshold in the past 2 weeks + 0.5V

33
Q

What is the nominal pulse width value on the Micra?

A

0.24ms, but can be programmed to 0.4ms

34
Q

How often does capture management conduct a threshold confirmation test when adaptive mode is programmed on a Micra?

A
  • done hourly

- confirmation is done with a pulse 0.125 V above the measured threshold

35
Q

At what voltage will the Micra PM automatically switch to OOO?

A

when the battery voltage gets to 2.5 V will switch to OOO, but can support telemetry for about 1yr after

36
Q

What does the A1 window represent when conducting a MAM test on a Micra AV?

A
  • start of the ventricular systole and AV valve (mitral/tricuspid) closure
  • result of QRS
37
Q

What does the A2 window represent when conducting a MAM test on a Micra AV?

A
  • end of ventricular systole and semilunar valve (aortic/pulmonic) closure
  • near or end of T-wave
38
Q

What does the A3 window represent when conducting a MAM test on a Micra AV?

A
  • diastole

- corresponds to E-wave on the doppler echo

39
Q

What does the A4 window represent when conducting a MAM test on a Micra AV?

A
  • atrial systole or contraction
  • window starts at beginning of the P-wave
  • corresponds to A-wave on doppler echo
40
Q

What does the Micra AV do to the A1 and A2 signals?

A

blanks them by having them fall into PVAB

41
Q

What does VE represent on a Micra AV egm?

A

it marks the end of the A3 window

42
Q

When does the A4 signal occur after the P-wave?

A

appx 100ms, marked by an AM on the egm

43
Q

What does AM represent on a Micra AV egm?

A
  • stands for Atrial Mechanical

- marks sensing of A4 signal

44
Q

At what atrial rate will a Micra AV lose the ability to track atrial activity?

A

atrial rate > 100bpm

45
Q

What is the AM-VP interval on a Micra AV?

A
  • starts with AM marker

- programmed short due to AM sensing occurring appx 100ms after the P-wave

46
Q

What is the nominal AM-VP interval on a Micra AV?

47
Q

What Micra AV feature switches to VVI+ at 40bpm if AV conduction is present?

A

AV Conduction Mode Switch

48
Q

How does the Micra AV perform conduction checks?

A
  • does VVI 40 sensing test
  • starts 1 min after VDD mode is programmed and doubles time up to 8hrs if conduction is present
  • then does the check q8hrs
49
Q

What is/are indications for a Micra AV?

A

pts with AVB only and adequate sinus rates

50
Q

What is/are indications for a Micra VR?

A

pts with AVB and AF

51
Q

When should the AV conduction mode switch feature be turned off on a Micra AV?

A

in patients with permanent AV block and junctional or ventricular escape (IVR) greater than 40 bpm

52
Q

When would the Micra AV switch from VVI+ 40 to back to VDD mode after a mode switch?

A

if 2 of 4 beats are VP at 40bpm

53
Q

What does the activity mode-switch feature do on a Micra AV?

A

switches to VDIR mode if exercise is detected and the current rate is low

54
Q

Which feature should be turned off if Rate Response is not appropriate for the patient?

A

turn off activity mode switch

55
Q

What happens when a Micra reaches RRT?

A

functions normally for 90 days, no changes are made

56
Q

What happens when a Micra reaches ERI?

A

mode changes to VVI at 65 bpm but can be reprogrammed if needed

57
Q

How long after a Micra reaches RRT will ERI occur?

A

90 days after RRT

58
Q

What happens to the Micra at the end of service (EOS)?

A

device permanently turns off pacing operations

59
Q

When performing a MAM test what mode should be used if atrial undersensing (p-waves but no AM marker) occurs?

A

perform test in VDD at 50bpm

60
Q

When performing a MAM test what mode should be used if atrial oversensing (AM marker but no p-waves) occurs?

A

perform test in VDI at 50bpm

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