Pacers

Question 1

Indications for insertion of pacemakers:

Answer 1

-Sinus node disease
-AV node disease
-Long QT syndrome
-Hypertrophic obstructive cardiomyopathy
-Dilated cardiomyopathy

“SALHD”

Question 2

PaSeR PM

Answer 2

1. Pased
2. Sensed
3. Response to Sensing
4. programability
5. multisite pacing

Question 3

O-
A-
V-
D-

Answer 3

O- none
A- atrium
V- ventricle
D- dual

Question 4

Failure to capture:

Answer 4

when the pacemaker’s electrical output fails to cause myocardial depolarization

Question 5

Failure to sense:

Answer 5

the pacemaker fails to recognize intrinsic cardiac electrical activity

Question 6

Indications for ICD:

Answer 6

o Ventricular tachycardia
o Ventricular fibrillation
o Post MI with an EF <30%
o Cardiomyopathy with an EF <35%
o Hypertrophic cardiomyopathy
o Awaiting a heart transplant
o Long QT syndrome

Question 7

ICD: Position 1

Answer 7

Shock Chambers

Question 8

ICD: Position 2

Answer 8

Anti-Tachycardia pacing chambers

Question 9

ICD: Position 3

Answer 9

Tachycardia Detection

Question 10

ICD: Position 4

Answer 10

Anti-Bradycardia pacing chambers

Question 11

An ICD cardioverts V-tach with________ joules.

Answer 11

1-30

Question 12

An ICD cardioverts V-Fib with________ joules.

Answer 12

10-30
-if an ICD acknowledges that a shock is needed, it will deliver six shocks

Question 13

Electrocautery =

Answer 13

most prevalent source of electromagnetic interference in the operating room

Question 14

Bipolar cautery

Answer 14

has the anode and cathode at the tip of the device less of a risk of EMI versus a monopolar cautery device which requires a grounding pad to be placed elsewhere on the body

Question 15

Application of a magnet on a pacemaker will…..

Answer 15

will set the pacemaker into the set asynchronous pacing rate –> may disable any rate modulation that could set with the pacemaker

Question 16

Application of a magnet on an ICD:

Answer 16

will disable the ability of ICD to shock VT or VF

Question 17

Application of a magnet on a dual pacemaker AND ICD:

Answer 17

Will ONLY disable the shock function

Question 18

Explain Asynchronous Pacing

Answer 18

-Pacer gives a constant rate
-No sense or inhibition
-There CAN be a competitive underlying rhythm
-A pacer spike delivered during ventricular depolarization can result in “R on T”

Example: AOO, VOO, DOO

Question 19

Single-Chamber Demand Pacing

Answer 19

-Think of this as a backup mode. It only fires when the native heart rate falls below a predetermined rate.

Example: AAI, VVI

Question 20

Dual-Chamber AV Sequential Demand Pacing

Answer 20

-This mode is very flexible and is the MOST COMMON mode of pacing.
-This mode makes sure the atrium contract first followed by the ventricle
-This improves AV synchrony

Example: DDD

Question 21

What is the best option for a surgeon to use for cautery?

Answer 21

Bipolar Device

Question 22

What I the most critical information to have preoperatively?

Answer 22

The patients underlying rhythm

Question 23

Pacemaker failure can be treated with ________, ________, and _________. (depends on underlying rhythm).

Answer 23

Isoproterenol, epinephrine, atropine

Question 24

Failure to sense occurs when the pacemaker does not sense __________.

Answer 24

The underlying cardiac rhythm

Question 25

Undersensing results in _____________ pacing

Answer 25

Asynchronous pacing

Question 26

Failure to capture occurs when the _______ does not ________ in response to a pacing stimulus.

Answer 26

ventricle, depolarize

Question 27

During failure to sense, the pacemaker ends an impulse at _______ times. You’ll see ________ _______ in places where you would otherwise not expect to see them.

Answer 27

sporadic, pacing spikes

Question 28

Failure to output can be caused by _______, ________, ________.

Answer 28

overspending, pulse generator failure, or lead failure.

Question 29

Contraindication for patients with pacer or ICD

Answer 29

MRI

Question 30

NOT Contraindications:

Answer 30

Lithotripsy (beam directed away from the pulse generator) and Electroconvulsive therapy

Question 31

SATA (ICD 1,2,3,4)

Answer 31

1. Shock Chambers
2. Anti-Tachycardia pacing chambers
3. Tachycardia sensing
4. Anti-Bradycardia pacing chambers

Question 32

Position 1: pacer

Answer 32

chamber paced

Question 33

Position 2: pacer

Answer 33

chamber sensed

Question 34

Position 3: pacer
O =
I =
T =
D =

Answer 34

Response to sensing
Ex. sensed intrinsic atrial beat will inhibit atrial pacing output and will trigger ventricular pacing

O = none
I = inhibited
T = triggered
D = dual (T+I)

Question 35

Position 4: pacer
R = ?
O= ?

Answer 35

Programmability
O= none
R = rate modultion (will increase the pacer’s lower heart rate limit in response to activity that may require an increased myocardial oxygen demand)

Question 36

Position 5: pacer

Answer 36

Multisite pacing (pacer may pace BOTH atria and/or BOTH ventricles