Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

8362 T&T Exam 2 > Mod V: Cardovascular Implantable Electronic Devices (CIED) > Flashcards

Mod V: Cardovascular Implantable Electronic Devices (CIED) Flashcards

1
Q

Cardovascular Implantable Electronic Devices (CIED)

Cardovascular Implantable Electronic Devices (CIED) are used for the Treatment & management of:

A

Cardiac conduction & Arrhythmia problems

Symptomatic bradycardia

(including that resulting from sinus node dysfunction)

Atrioventricular (AV) conduction block

(after catheter ablation of the AV node or junction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Perioperative mgnt of patients with Cardovascular Implantable Electronic Devices (CIED)

Pacing can be provided in several ways, including

A

Application of external pacing pads

Urgent insertion of a transvenous pacing lead via central venous access

Implantation of permanent intracardiac leads along with a pulse generator.

Regardless of how it is provided, pacemaker programming (and therefore pacemaker function) must always be individualized to the needs of the individual patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Perioperative mgnt of patients with Cardovascular Implantable Electronic Devices (CIED)

The ‘best’ perioperative care of a patient with a CIED usually comes from the recommendations from which individual or team?

A

The physician/care team who usually monitor/manage the CIED (the CIED ‘team’)

Such recommendations should routinely be sought in advance whenever feasible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Perioperative mgnt of patients with Cardovascular Implantable Electronic Devices (CIED)

Electronic device that delivers electrical stimulation to heart

A

Cardovascular Implantable Electronic Devices (CIED)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Perioperative mgnt of patients with Cardovascular Implantable Electronic Devices (CIED)

Pacing can be delivered to

A

a single chamber (atrium or ventricle only),

dual chambers (atrium and ventricle), or

multiple chambers (in biventricular pacing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Perioperative mgnt of patients with Cardovascular Implantable Electronic Devices (CIED)

Leads - Pacing can use either:

A

unipolar or bipolar leads.

Over the last 15 yr, bipolar leads have been predominantly used. With a bipolar lead, both the cathode and anode are present on the lead itself and thus the distance between them is much smaller than with a unipolar lead (where the pulse generator functions as the anode). The advantage of the bipolar configuration is reduced susceptibility to electromagnetic interference (EMI).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cardovascular Implantable Electronic Devices (CIED)

How do Cardovascular Implantable Electronic Devices (CIED) function?

A

Sensing intrinsic cardiac electrical potentials

device can sense intrinsic electrical activity in the chamber where the lead is placed to either inhibit or trigger pacing in that chamber

If no spontaneous depolarization of the chamber is sensed within the programmed limits, the device will deliver a pacing stimulus

If a spontaneous chamber depolarization occurs and is sensed, the device will inhibit the delivery of a pacing stimulus and wait for a subsequent depolarization during the next pre-set time interval.

A dual-chamber pacing mode allows for both sensing and subsequent triggering or inhibition of pacing in one or both chambers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Implantable Pacemaker System

What are the components of a pacemaking system?

A

Impulse generator

Leads

(carry the electrical impulse to the patient’s heart)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Implantable Pacemaker System

What’s the function of PM leads?

A

Insulated wires tha deliver electrical impulses from the pulse generator to the heart

Leads carry the electrical impulse to the patient’s heart

Transmit electrical signals from the heart to the pulse generator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Implantable Pacemaker System

How are PM leads connected to the heart chambers?

A

Through the vena cava (transvenous leads), or

Sewn onto the surface of the heart (epicardial leads)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Implantable Pacemaker System

In terms of polarity what are the different types of PM leads?

A

Unipolar leads (one electrode per lead)

Because two electrodes are required to complete a circuit, the second electrode in a unipolar configuration is the metal generator case

Use of the case as an electrode requires that the generator pocket be devoid of gas, and electrical continuity has reportedly been disrupted by the use of nitrous oxide​

Bipolar leads (two electrodes per lead), or

Multipolar leads (multiple electrodes and wires contained within one lead with connections in multiple chambers)

Pacemaker leads are generally placed in the right atrial (RA) appendage, right ventricle (RV), or, in a dual-chamber device, both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Implantable Pacemaker System

PM leads with pacing polarity are more sensitive to the effects of EMI?

A

PMs with unipolar leads are more sensitive to the effects of EMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Implantable Pacemaker System

Most pacemaking systems (except older Autocapture devices from St. Jude Medical) pace in which pacing polarity mode? why?

A

Bipolar mode

because bipolar pacing usually requires less energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Implantable Pacemaker System

Which sensing polarity modality is more resistant to interference from muscle artifacts or stray electromagnetic fields

A

Bipolar sensing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Implantable Pacemaker System

What are Indications for permanent pacing?

A

Sinus node disease

(Symptomatic diseases of impulse formation)

Atrioventricular nodal disease

(Symptomatic diseases of impulse conduction)

Long QT syndrome

Hypertrophic obstructive cardiomyopathy

Dilated cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Implantable Pacemaker System

Where are Implantable Pacemaker System pulse generator usually implanted in the body?

A

Infraclavicular region

SubCutaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Implantable Pacemaker System

What are the components of Implantable pulse generator of a Implantable Pacemaker System?

A

Power source

Circuitry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Implantable Pacemaker System

How long does the Power source of Implantable pulse generator last?

A

5 to 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Implantable Pacemaker System

What’s the function of an Implantable pulse generator circuitry?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Implantable Pacemaker System

What’s the function of a pacemaker electrode?

A

Conductor located at the end of the lead

Delivers the impulse to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Implantable Pacemaker System

How does Myocardial tissue participate in the Implantable Pacemaker System?

A

Receives electrical impulse from the lead and stimulates the heart

Produces an electrical signal that the lead senses, or “sees”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Implantable Pacemaker System

Graphical representation of a modern pacemaker: see picture

A

Graphical representatio of a modern pacemaker

Note: Generator, RA an RV leads

Green lead => BiVent PCMkr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Implantable Pacemaker System - Important Definitions

The process whereby a pcm spike generates a mechanical contraction (Ppcm spike a/w QRS complex) is known as ?

A

Capture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Implantable Pacemaker System - Important Definitions

The process whereby the PCM fails to deliver sufficient energy to the myocardium to produce a depolarization is also known as:

A

Loss of Capture

The PCM sees other things, fires but does not generate a QRS

The question you must ask is “why?”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Implantable Pacemaker System - Important Definitions

What are causes of “Loss of Capture”?

A

Inappropriate output setting

Increased resistance to conduction

Dislodged/fractured lead

Hypokalemia

Cardiac tissue is refractory /hyperpolarized

Hypokalemia lowers the RMP which pushes the pacing threshold by

Faulty cable connection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Implantable Pacemaker System - Important Definitions

Minimum amount of energy required to consistently capture the myocardium and cause depolarization/contraction

A

Pacing Threshold

Measured by amplitude (mA or V) & duration (mS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Implantable Pacemaker System - Factors Affecting Pacemaker Threshold

What are the things you can affect? How can you increase pcm threshold? aka (make it more difficult to pace)

A

Acidosis - Hyperglycemia - Hyperoxemia

Hypokalemia - Hypernatremia

B-blockers - Procainamide (toxic dose) - Mineralocorticoids

Myocardial scar tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Implantable Pacemaker System - Factors Affecting Pacemaker Threshold

What are the things you can affect? How can you decrease pcm threshold? aka (make it easier to pace)

A

Stress - Hypoxemia - Hyperkalemia

Ephedrine - Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Implantable Pacemaker System - Important Definitions

undersensing (intrinsic activity is not detected)

A

Undersensing

Cuases over pacing – sense activity and tries to oeverpace… why?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Implantable Pacemaker System - Important Definitions

Causes of Undersensing - senses activity and tries to oeverpace… why?

A

Battery depletion

Decreased QRS voltage

Fusion beat

Dislodged/fractured lead

Inappropriate sensitivity setting

Myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Implantable Pacemaker System - Important Definitions

ventricular activity in the absence of true electrical systoles is also known as:

(“detection” of events unrelated to intrinsic activity)

Occurs when pcm sense a potential (em interfere, p-wave, etc) but refuses to fire

Oversensing but underfiring

Really problematic w/ electromagn interference

A

Oversensing

32
Q

Generic Codes for Pacemakers

A

Generic Codes for Pacemakers

Revised recently

North Am and Britisk EP society

33
Q

Generic Codes for Pacemakers - Types of Pacing Modes

Simple form of fixed rate pacemaker

Discharges at a preset rate irrespective of the intrinsic heart rate

A

Asynchronous Pacing

AOO → Asynchronous atrial only pacing

VOO → Asynchronous ventricular only pacing

DOO → Asynchronous AV sequential pacing

34
Q

Types of Pacing Modes

Asynchronous Pacing - Competes with the patient’s intrinsic rhythm - Provoke an

A

R on T phenomenon → induction of tachyarrhythmias

35
Q

Generic Codes for Pacemakers - Types of Pacing Modes

Asynchronous Modes - AOO

A

AOO

36
Q

Generic Codes for Pacemakers - Types of Pacing Modes

Asynchronous Modes - VOO

A

VOO

37
Q

Generic Codes for Pacemakers - Types of Pacing Modes

Asynchronous Modes - DOO

A

DOO

38
Q

Types of Pacing Modes

Single Chamber Atrial Pacing (AAI)

A

Single Chamber Atrial Pacing (AAI)

39
Q

Types of Pacing Modes

Single Chamber Ventricular Pacing (VVI)

A

Single Chamber Ventricular Pacing (VVI)

40
Q

Types of Pacing Modes

Two leads One lead implanted in the atrium - One lead implanted in the ventricle - Atrium is stimulated first to contract, then after an adjustable PR interval ventricle is stimulated to contract

A

Dual Chamber AV Sequential Pacing

(DDD, DVI, DDI, & VDD)

41
Q

Types of Pacing Modes - Dual Chamber AV Sequential Pacing

Benefefits of Dual Chamber AV Sequential Pacing

A

Preserve AV synchrony

Most common modes used today

Goal is to Preserve AV synchrony

42
Q

Types of Pacing Modes - Dual Chamber AV Sequential Pacing

Indication for Dual Chamber AV Sequential Pacing

A

AV block, carotid sinus syncope, & sinus node disease

43
Q

Types of Pacing Modes - Dual Chamber AV Sequential Pacing

A Benefefit of Dual Chamber AV Sequential Pacing is that it preserves AV synchrony. Why is that important?

A

Why is AV synchrony important: atrial kick, R-on-T

44
Q

Preoperative Evaluation

A

Coexisting disease

High dose opioid (fent) can cuase bradycardia

History vertigo, syncope, light headedness, or return of pre-pacemaker symptoms

Know the hx

Optimize Electrolytes

Obtain CXR

(if no information on device type)

EKG

(to determine that pcm is firing)

Pacemaker interrogation

(must be performed w/in 1 year – available – can be done by phone)

45
Q

Electromagnetic Interference (EMI)

Measures to minimize effect of Electromagnetic Interference (EMI)

A

Bipolar cautery vs. monopolar if possible

Monopolar cautery use

46
Q

Electromagnetic Interference (EMI)

Monopolar cautery use

(Since we cannot control use of stuffs like Bovie)

A

Grounding plate close to surgical site & as far away from pacemaker as possible

Do not use within 15 cm of pacemaker

<strong>Procedures above the umbilicus the most risky</strong>

Limit bursts to 1 sec every 10 sec

Monitor cardiac rhythm/ peripheral pulse with pulse oximeter or arterial waveform (EKG affected by interference)

Palpate pulse to ensure mechanical is occuring

Have alternative temporary pacing methods available in OR

Most preferred

Emergency drugs: atropine/isoproterenol

Magnet?

could switch pcm to asynchronous mode

47
Q

Intraoperative management of severe bradycardia:

A
  1. Administer O2 & control airway
  2. Give Atropine
  3. Give Isoproterenol
  4. Place magnet over pacemaker (convert demand to asynchronous)
  5. Initiate transcutaneous external pacing
48
Q

Postoperative Management

A

Any pacemaker that was reprogrammed for the operating room should be reset appropriately

Any pacemaker that was reprogrammed (magnet applied, etc) for the operating room should be reset appropriately by proper qualified provider

Have the device interrogated by a competent authority

For non reprogrammed devices most manufacturers recommend interrogation to ensure proper functioning and remaining battery life if any electrocautery was used

49
Q

Implantable Cardioverter Defibrillators

History:

A

1985: Implantable cardioverter defibrillators (ICD’s)

Treat fatal tachyarrhythmias

50
Q

Implantable Cardioverter Defibrillators

Current:

A

Technologic advances revolutionized pacemakersCurrent

combined pacemaker/ICD device

most pcm today are this way

51
Q

Implantable Cardiac Defibrillator

Mechanism of Action:

A

ICD’s measure each R-R interval

The internal computer chooses antitachycardia pacing or shock depending upon the presentation and device programming

Most ICD’s are programmed to reconfirm VT or VF after charging to prevent inappropriate therapy

Typically ICD’s deliver 6-18 shocks per event

Most ICD’s will begin pacing if the R-R interval is too long

52
Q

Implantable Cardiac Defibrillator

Indications:

A

Ventricular Tachycardia

Ventricular Fibrillation

EF≤35%

Hypertrophic Cardiomyopathy

Awaiting heart transplant

Long QT syndrome

Arrhythmogenic Right ventricular Dysplasia

Brugada syndrome (RBBB, S-T segment elevation in leads V1-V3)

53
Q

Implantable Cardiac Defibrillator

Most devices will suspend tachydysrhythmia detection

A

True

54
Q

Implantable Cardiac Defibrillator

In general magnets will not affect the brady pacing mode or rate

A

True

55
Q

Implantable Cardiac Defibrillator

Interrogating the device and calling the manufacturer is the most reliable method to determine magnet response

A

True

(ICD must be interrogated w/in 6 mos)

56
Q

Implantable Cardiac Defibrillator

Preanesthetic evaluation:

A

Evaluate and optimize co-morbid diseases

Every ICD patient should undergo ICD interrogation

Disabling of antitachycardia therapy

(If no risk, may not have todo anythin)

57
Q

Implantable Cardiac Defibrillator

Deactivation Guide to ICD

A

Place magnet over device

Do you hear beeping ?

58
Q

Implantable Cardiac Defibrillator - Deactivation Guide to ICD

Place magnet over device

Do you hear beeping ? Yes:

A

Hold magnet over device for at least 30 sec

59
Q

Implantable Cardiac Defibrillator - Deactivation Guide to ICD

Place magnet over device

Do you hear beeping ? No:

A

Check magnet position

Contact ICD programmer if still not heard

If no beep tone, must be reinterrogated by qualified personel

60
Q

Implantable Cardiac Defibrillator - Deactivation Guide to ICD

Place magnet over device

You hear beeping

You Hold magnet over device for at least 30 sec

Did beeping tone change to continuous tone? No:

A

Device can not be turned off with magnet. ICD programmer required

Magnet will inhibit tachy therapy & can be taped over ICD to continue inhibition

Tones will continue as long as magnet properly positioned

Upon removal, device will return to normal operation

61
Q

Implantable Cardiac Defibrillator - Deactivation Guide to ICD

Place magnet over device

You hear beeping

You Hold magnet over device for at least 30 sec

Did beeping tone change to continuous tone? Yes:

A

Device is off and will not deliver tachy therapy. Brady therapy not effected

62
Q

Implantable Cardiac Defibrillator - Deactivation Guide to ICD

How do you turn a deactivated device back on?

A

Apply magnet for 30 sec.

Listen for tone to change from Continuous to beeping tone

If no beep tone, must be reinterrogated by qualified personel

63
Q

Implantable Cardiac Defibrillator

Intraoperative Management of Implantable Cardiac Defibrillator

A

ECG Monitoring

Ability to deliver external cardioversion or defibrillation during the time of ICD disablement

If cardioversion or defibrillation is needed the pads should be placed to avoid the pulse generator

ICD’s should be disabled prior to insertion of a central line to prevent inappropriate shock and possible ICD failure

64
Q

Electromagnetic Interference (EMI) - Defibrillation/Pacing

Position paddles

A

Position paddles as far away from CIED site as possible

Anterior to posterior positioning optimal

Very important in emergency

Could use ant lateral if unable to get posterior

65
Q

Implantable Cardiac Defibrillator

Post op Evaluation:

A

ICD must be interrogated and re-enabled

Pacing parameters should be checked and reset as necessary

66
Q

Pre- and Intraoperative management of patients w/ a pacemaker or ICD

Before planned surgery or other interventional procedure, obtain

A

Recent interrogation report regarding CIED function

(typically, this should be w/in 6 mo for an ICD, and 12 mo for a PM)

67
Q

Pre- and Intraoperative management of patients w/ a pacemaker or ICD

Before planned surgery or other interventional procedure, what must you do if a recent report showing normal function of the CIED is not available?

A

Consult the CIED physician/ care team for a perioperative management plan, and to arrange for CIED interrogation

Note whether the CIED is an ICD or a PM

68
Q

Pre- and Intraoperative management of patients w/ a pacemaker or ICD

What must you do if Electromagnetic Interference (EMI) is likely to occur in the vicinity of the CIED, the CIED is either an ICD* or a PM, and the pt is pacing dependent?

A

If the device CIED is an ICD

Consult the CIED physician/care team to disable antitachycardia therapy immediately before the procedure

In some cases, this must be accomplished w/ a programing machine

In other cases, this may be accomplishd w/ a magnet

For both ICD an PM

Consult the CIED physician/care team to change the CIED (ICD or PM) to an asynchronous mode immediately before the procedure

In some cases. this must be accomplished w/ a programing machine

In other cases, this may be accomplished w/ a magnet

If device is an ICD, the pacing made cannit be chnaged w/ a magnet

At the conclusion of the surgical or other interventional procedure, proceed to post operative managment

69
Q

Pre- and Intraoperative management of patients w/ a pacemaker or ICD

What must you do if Electromagnetic Interference (EMI) is likely to occur in the vicinity of the CIED, the CIED is an ICD

A

Consult the CIED physician/care team to disable antitachycardia therapy immediately before the procedure

In some cases, this must be accomplished w/ a programing machine

In other cases, this may be accomplishd w/ a magnet

70
Q

Pre- and Intraoperative management of patients w/ a pacemaker or ICD

What must you do if Electromagnetic Interference (EMI) is likely to occur in the vicinity of the CIED, the CIED is either an ICD or a PM, but the pt is NOT pacing dependent?

A

At the conclusion of the surgical or other interventional procedure, proceed to postoperative management

71
Q

Post-operative management of patients w/ a pacemaker or ICD

What is the most important question you must ask?

A

Was the CIED (ICD or PM) programmed for the surgical procedure?

72
Q

Post-operative management of patients w/ a pacemaker or ICD

How must a CIED (ICD or PM) that was programmed for the surgical procedure be managed post-op?

A

Continuous monitoring w/ both ECG and Pulse oximetry, and

Consultation w/ the CIED physician/care team for device interrogation and restoration of appropriate settings

If CIED is functionning properly and patient is stable, discharge to hospital ward or home, as appropriate

Patient should resume usual CIED followup after discharge

73
Q

Post-operative management of patients w/ a pacemaker or ICD

How must a CIED (ICD or PM) that was Not programmed for the surgical procedure be managed post-op if an EMI did occur during the procedure?

A

Continuous monitoring w/ both ECG and Pulse oximetry, and

Consultation w/ the CIED physician/care team for device interrogation and restoration of appropriate settings

If CIED is functionning properly and patient is stable, discharge to hospital ward or home, as appropriate

Patient should resume usual CIED followup after discharge

74
Q

Post-operative management of patients w/ a pacemaker or ICD

How must a CIED (ICD or PM) that was Not programmed for the surgical procedure be managed post-op, if an EMI did not occur during the procedure, but additional considerations such as “observed delivery of an ICD shock, or reasons to suspect CIED malfunction exist?

A

Continuous monitoring w/ both ECG and Pulse oximetry, and

Consultation w/ the CIED physician/care team for device interrogation and restoration of appropriate settings

If CIED is functionning properly and patient is stable, discharge to hospital ward or home, as appropriate

Patient should resume usual CIED followup after discharge

75
Q

Post-operative management of patients w/ a pacemaker or ICD

How must a CIED (ICD or PM) that was Not programmed for the surgical procedure be managed post-op, if an EMI did not occur during the procedure, and No additional considerations such as “observed delivery of an ICD shock, or reasons to suspect CIED malfunction exist?

A

If CIED is functioning properly and patient is stable, discharge to the hospital ward or home, as appropriate

Patient should resume usual CIED followup after discharge

76
Q

Perioperative mgnt of patients with Cardovascular Implantable Electronic Devices (CIED)

Important information to be given to the CIED team so they can provide specific recommendations to the surgical/procedural team regarding the preoperative preparation of the patient’s CIED for the planned procedure

A

Intended surgical procedure

Location of pulse generator

Patient position during the procedure

Type of electrocautery to be used

Other sources of EMI likely to be present

Whether cardioversion or defibrillation will be necessary

Availability of Industry Employed Allied Health Professional or knowledgeable personnel with manufacturer-specific programmer

Anticipated post-procedural disposition

(e.g. anticipated discharge to home <23 h, inpatient admission to critical care bed, telemetry bed)

Other circumstances

(cardiothoracic or chest wall surgical procedure that could impair/damage or encroach upon the CIED leads, anticipated large blood loss, operation in close proximity to CIED)

8362 T&T Exam 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions