ReTest Desk 1 Flashcards
The following is true about atrial fibrillation except
Atrial fibrillation is the most common arrhythmia seen in clinical practice
Atrial fibrillation causes 20% of all strokes
Conservative estimates predict 5 million people will have afib by 2050
The mortality rate for a patient with afib is nearly 75%
The mortality rate for a patient with afib is nearly 75%
Atrial fibrillation is noted for
Regular QRS intervals
Chaotic atrial activity
Discernable P-waves
Heightened exercise tolerance
Chaotic atrial activity
Symptoms of Afib include all of the following except
Weakness and fatigue
Regular pulse rate
Palpitations and chest pain
Shortness of breath and confusion
Regular pulse rate
All of the following are suspected causes of atrial fibrillation except
Stroke
Sleep apnea
Exposure to stimulants like caffeine, tobacco or alcohol
High blood pressure
Stroke
This structure is a suspect in clot formation in patients with atrial fibrillation.
Left atrium
Right atrium
Left atrial appendage
The coronary sinus
Left atrial appendage
These structures are suspected in starting atrial fibrillation.
The lungs
The SVC and aorta
The pulmonary veins
The pulmonary arteries
The pulmonary veins
Progression of Atrial fibrillation is defined as
Permanent - Persistent - Paroxysmal
Paroxysmal - Permanent - Persistent
Paroxysmal - Persistent - Permanent
Persistent - Paroxysmal - Permanent
Paroxysmal - Persistent - Permanent
The following are known complications of Afib ablation except
Atrial esophageal fistula and phrenic nerve damage
Cardiac tamponade from cardiac perforation
Deep venous thrombosis in the lower leg
Stroke and fluid overload
Deep venous thrombosis in the lower leg
“Entrance” and “Exit” block of the pulmonary veins refers to:
Atrial fibrillation exiting the heart
Pulmonary vein potentials not able to exit and enter the pulmonary vein
The pulmonary veins are not associated with atrial fibrillation in the patient
The atrial fibrillation is located entirely in the left atrium
Pulmonary vein potentials not able to exit and enter the pulmonary vein
Which of the following catheters are commonly utilized for an AF ablation?
HRA, RVOT, Ablation, Halo, Lasso
Ultrasound, RVOT, His
ICE, Lasso, Ablation, Coronary Sinus
Coronary Sinus, Ablation, Halo, His
ICE, Lasso, Ablation, Coronary Sinus
What catheter is commonly inserted when performing a pericardiocentesis?
JR 4
JL 3
JL 4
Pig tail
Pig tail
The initiation of A-Fib most commonly originates from
Left atrial appendage
Inferior vena cava
Posterior atrial wall
Pulmonary veins
Pulmonary veins
Patients with atrial flutter
Have a higher risk of developing atrial fibrillation
Have a “saw tooth” appearance pattern on the 12 lead ECG
Have a higher risk of stroke
All are correct
All are correct
Symptoms can include all of the following except
Dizziness
Palpitations
Frequency and urge to urinate
Shortness of breath
Frequency and urge to urinate
Typical flutter uses all the following structures in its circuit except
Tricuspid annulus
Mitral annulus
Lateral right atrial wall
Atrial septum
Mitral annulus
The perpetuation of typical atrial flutter requires:
An area of slow conduction
The SVC
The distal coronary sinus
The left atrial appendage
An area of slow conduction
Typical counter clockwise flutter accounts for what percentage of all flutter cases?
50%
30%
75%
90%
90%
Clock-wise flutter is characterized by all of the following except
The flutter wave front traveling down the atrial septum
Positive P-waves in the inferior leads
The wave front traveling up the lateral anterior right atrial wall
Negative P-waves in the inferior leads
Negative P-waves in the inferior leads
Atypical atrial flutter may be the result of
Scarred atrial tissue
Previous surgical intervention
Previous ablative therapies
All are correct
All are correct
All of the following are elements of ‘entrainment’ except
Is a maneuver to assist in locating the structures in the flutter circuit
Requires pacing the atrial tissue at a faster rate than the flutter rate
Is a maneuver to help move the wave front to a different location
Requires the flutter to advance to the pacing cycle length while pacing
Is a maneuver to help move the wave front to a different location
Cardioversion of atrial flutter includes all of the following except
Need for the sync button to be activated before the shock is delivered
Can usually be accomplished with 50-100 joules
Can usually be accomplished with 10-20 joules
Should be performed in the presence of the Electrophysiologist
Can usually be accomplished with 10-20 joules
All of the following describe atrial tachycardia except
An atrial focus other than the SA node
An ectopic atrial pacemaker coming from structures near the atria
An atrial focus coming from the pulmonary veins with an atrial rate greater than 300 beats per minute
An atrial focus coming from the pulmonary veins causing a tachycardia rate of 150 beats per minute
An atrial focus coming from the pulmonary veins with an atrial rate greater than 300 beats per minute
All of the following are symptoms of atrial tachycardia except
Dizziness
Chest pain
Palpitations
Slow heart rate
Slow heart rate
All of the following are common locations for atrial tachycardia except
The anterior left ventricle
The crista terminalis
The pulmonary veins
The coronary sinus ostium
The anterior left ventricle
The following are classified as atrial tachycardias except
Focal Atrial tachycardias
Multifocal atrial tachycardias
Intra-atrial re-entry tachycardia
Atrial flutter
Atrial flutter
Atrial tachycardia P wave morphology will most likely resemble the sinus P wave for which focus
Left inferior pulmonary vein
Coronary sinus ostium
Superior vena cava
Tricuspid annulus
Superior vena cava
Inappropriate sinus tachycardia can have the following characteristics except
Comes from dysautonomia or the sinus node itself
Can frequently occur in young women
Can be brought on by emotional distress
Is easily manageable with medications
Is easily manageable with medications
Ventricular entrainment during atrial tachycardia with tachycardia continuing after pacing reveals
V-A-V response
A-V-A response
V-A-A-V response
A-V-V-A response
V-A-A-V response
The coronary sinus catheter is important for determining activation sequence in atrial tachycardia diagnosis
True
False
True
Multifocal atrial tachycardia refers to
A tachycardia focus from more than one area of the atrium
A tachycardia focus coming from the sinus node
A tachycardia focus coming from the AV node
A tachycardia focus coming from more than one area of the ventricle
A tachycardia focus from more than one area of the atrium
Bradycardia is defined as
A slow heart rhythm with rates of 70-100 beats per minute
A heart rate of 65 with blood pressures below 80/50
A slow heart rhythm with rates of 70 and blood pressure of 60/40
A slow heart rhythm with rates below 60 and dizziness
A slow heart rhythm with rates below 60 and dizziness
Symptoms of bradycardia can include all of the following except
Syncope, dizziness
Fatigue, shortness of breath
Feeling of alertness and exertional tolerance
Confusion and diminished mental acuity
Feeling of alertness and exertional tolerance
The following can cause bradycardia except
Sick Sinus Syndrome
An accessory pathway
Chronotropic Incompetence
Sinus arrest
An accessory pathway
First degree AV block is defined by
A PR interval of 200 ms or greater
More P waves then QRS complexes
A need for a permanent pacemaker
Dissociated P waves
A PR interval of 200 ms or greater
Second degree heart block Wenckebach is characterized by
Dissociated P waves
Second degree heart block Wenckebach is characterized by
Progressively lengthening PR interval followed by a dropped QRS
P waves conducting to a QRS on every other beat
Progressively lengthening PR interval followed by a dropped QRS
Third degree heart block is characterized by
Dissociated (no relationship) P waves to the QRS complex
PR intervals greater than 300 ms
Progressively lengthening PR interval followed by a dropped QRS
P waves conducting to a QRS on every other beat
Dissociated (no relationship) P waves to the QRS complex
The following are tests used to try and document bradycardia except
Holter monitor
Event recorder
Implantable event recorder
Implanted permanent pacemaker
Implanted permanent pacemaker
A corrected sinus node recovery time (CSNRT) is characterized by
The time it takes for a sinus beat to occur after rapid atrial pacing
Subtracting the sinus cycle length from the time it takes a sinus beat to occur after rapid atrial pacing
Rapid atrial pacing followed by rapid ventricular pacing.
The time it takes to place a pacemaker
Subtracting the sinus cycle length from the time it takes a sinus beat to occur after rapid atrial pacing
An EP study scheduled to diagnose causes of bradycardia would include
HRA, HIS and RV catheters
HIS, CS, RV and Ablation catheters
HRA, CS and Transeptal Halo catheter
RVOT, HRA and RVA catheters
HRA, HIS and RV catheters
A junctional escape rhythm is characterized by all of these except
A rate of 40-60
A narrow complex QRS rhythm
A wide complex paced rhythm
A proximal AV nodal block
A wide complex paced rhythm
Baseline EGM measurements are generally performed at what recording speed?
25 mm/second
100 mm/second
200 mm/second
500 mm/second
200 mm/second
Measuring the precise moment in time when the depolarization/activation wave front passes thought the mid-point between an electrode pair, manifested by the apex point of the EGM deflection is known as:
Zero-Cross Over Point Approach
Onset Approach
Isoelectric Approach
Gained Approach
Zero-Cross Over Point Approach
Which of the following are common surface ECG intervals measured?
PR, A-A, R-R, QRS
PR, QRS, QT, P-P, R-R
A-A, AH, HV, QRS, V-V
A-A, QRS, P-P, R-R, V-V
PR, QRS, QT, P-P, R-R
Which of the following are common EGM intervals measured?
PR, A-A, R-R, QRS
PR, QRS, QT, P-P, R-R
A-A, AH, HV, QRS, V-V
A-A, QRS, P-P, R-R, V-V
A-A, AH, HV, QRS, V-V
A normal PR interval is
90 ms
120 ms
220 ms
320 ms
120 ms
A normal QRS interval is
90 ms
125 ms
225 ms
320 ms
90 ms
Which mechanism is defined by (1) slow zone of conduction, (2) unidirectional block in part of the tissue, and (3) slow enough conduction allowing tissue to become refractory?
Automaticity
Triggered
Reentry
Foci
Reentry
A normal H-V interval is
20 ms
50 ms
70 ms
100 ms
50 ms
An ABNORMAL A-H interval would be
20 ms
50 ms
70 ms
100 ms
20 ms
What interval measurement could indicate electrolyte disturbances like hypokalemia and hypocalcemia?
PR
AH
RR
QT
QT
Bradycardia is defined as a heart rhythm that is slow at a rate below __________.
40 bpm
50 bpm
60 bpm
80 bpm
60 bpm
Failure of the SA Node to adequately generate an appropriate number of intrinsic (native) electrical impulses defines which term?
Failure of impulse propagation
Failure of impulse generation
Automaticity
Triggered activity
Failure of impulse generation
Failure of the sufficient electrical impulse propagation by the AV node is known as
Failure of impulse propagation
Failure of impulse generation
Automaticity
Triggered activity
Failure of impulse propagation
The intrinsic (natural) ability of cardiac cells to spontaneously and repetitively generate electrical impulse for depolarization is known as
Failure of impulse propagation
Failure of impulse generation
Automaticity
Triggered activity
Automaticity
What are the three (3) different mechanisms of activation that propagate tachycardias?
Propagation, generation, automaticity
Reentry, autocentricity, triggered
Generation, reentry, triggered
Reentry, triggered, automaticity
Reentry, triggered, automaticity
Which of the following criteria is required for reentry?
Slow zone of conduction
Slow enough conduction allowing tissue to become refractory
Unidirectional block
All answers are correct
All answers are correct
Activity which propagates double activation of a cardiac cell from a single initial activation, resulting from the presence of upward deflections is known as which mechanism of activation?
Reentry
Autocentricity
Automaticity
Triggered activity
Triggered activity
Delayed after depolarization (DAD) occur in which phase of the action potential of triggered activity?
Phase 1
Phase 2
Phase 3
Phase 4
Phase 4
Regarding tachycardias, which is the most common mechanism of activation?
Triggered
Reentry
Intrinsic
Automaticity
Reentry
What is the heart rate in beats per minute for a patient with a tachycardia rate of 320 msec?
178
198
188
208
188 bpm
60,0000/320
The formula for cSNRT is:
(RCL-BCL)/2
SNRT-SCL
(BCL-RCL)/2
SCL-SNRT
SNRT-SCL
Which of the following mechanisms of tachycardia is the most common?
Intrinsic
Automaticity
Reentry
Triggered
Reentry
The most common site of triggers for atrial fibrillation is/are the:
Pulmonary veins
Crista terminalis
Pulmonary arteries
Eustachian Ridge
Pulmonary veins
Burst pacing protocol consists of delivering which of the following:
A premature extra stimuli into a fixed pacing train
Decremental pacing stimuli within a pacing train
An alternating long short cycle length within a pacing train
A fixed sequence pacing train
A fixed sequence pacing train
While advancing the RV catheter, the patient suddenly goes into complete heart block. What would be the most likely explanation for this?
The patient has an existing RBBB
The patient has an existing LBBB
The patient has an existing RBBB and SA nodal sisease
The patient has an existing R postero-fasicular BBB
The patient has an existing LBBB
Following successful atrial flutter ablation, the stim to activation time as measured on the distal pole of the multi-pole catheter should measure at least _____ msec.
100
150
50
200
150
What is the most common site for idiopathic VT?
The right ventricular outflow tract
The left ventricular outflow tract
The scar margin from a myocardial infarction
The left and right bundle branches
The right ventricular outflow tract
With the exception of a local stimulus of above normal strength, which of the following refractory periods describe the time during repolarization in which the longest coupling interval (S1, S2) of input into a tissue fails to produce capture?
Effective
Functional
Absolute
Relative
Effective
Which of the following are appropriate high/low pass filters for intracardiac electrograms in Hertz?
5.0/100
.05/500
30/500
0.5/100
30/500
During cryoablation for atrial fibrillation, which of the following ensures avoidance of phrenic nerve damage?
High output pacing during ablation
4-minute ablation sessions
Sustained tissue temperatures of 45-50°C
2-minute ablation sessions
High output pacing during ablation
Which one of the following may be a sign of an embolic stroke immediately after a successful transseptal puncture?
Presence of a U-wave on ECG
ST elevation on leads V1-V2
Facial weakness and drooping on one side of the patient
Cessation of a headache
Facial weakness and drooping on one side of the patient
Which of the following is the commonly used needle to obtain transseptal access?
BSD needle
Brockenbrough needle
Seldinger needle
Mullen’s needle
Brockenbrough needle
What diagnostic catheter is used to drain the pericardial sac for a pericardiocentesis?
JL 4
MPA I
JR 4
Pigtail
Pigtail
In a typical bundle branch reentry (BBR) ventricular tachycardia, the reentry signal initiates antegrade down the right bundle branch (RBB) to which of the following to complete the reentry circuit?
Retrograde up the right bundle branch (RBB)
Retrograde up the left bundle branch (LBB)
Retrograde up the accessory pathway (AP)
Antegrade down the left bundle branch (LBB)
Retrograde up the left bundle branch (LBB)
Which of the following is MOST appropriate for a 14-year-old female patient who requires an ablation for AVNRT?
Laser ablation
4 mm cryoablation
8 mm non-irrigated radio-frequency ablation
3.5 mm irrigated radio-frequency ablation
4 mm cryoablation
All of the following are monitored and documented during a typical tilt table test (TTT) EXCEPT:
Oxygen saturation
Blood pressure
Heart rate
ECG rhythm
Oxygen saturation
To minimize the effects of signal artifact or environmental noise, how must all EP lab equipment must be set up?
Enable 60 cycle noise filter
Combine all EP equipment and control room peripheral equipment onto the same power circuit
Keep signal gain to less the 0.5 mV
Isolate all EP equipment to a separate designated power circuit
Isolate all EP equipment to a separate designated power circuit
If an atrial flutter cycle length is 280 bpm, then what is the cycle length in milliseconds?
244 ms
241 ms
204 ms
214 ms
214 ms
Ablating which section increases concern and risk for damaging the esophagus?
Pulmonary artery
Pulmonary veins
Posterior LA
Lateral LA
Posterior LA
During an AF ablation using the pulmonary vein isolation (PVI) technique, pacing the coronary sinus (CS) will do which of the following?
Check for entrance block
Check for exit block
Check for residual pulmonary vein (PV) signals
Verify which pulmonary vein (PV) to ablate
Check for an entrance Block
What is an upper acceptable value for a corrected SNRT?
400 ms
700 ms
540 ms
650 ms
540 ms
What cryo-ablation temperatures cause effective tissue damage and lesion formation?
45 to 65°F
45 to 55°F
45 to 55°C
45 to 65°C
45 to 65°F
Successful flutter ablation should show stimulus to activation conduction time measuring at least:
≤20 ms
<120 ms
>150 ms
>250 ms
> 150 ms
Which of the following verifies successful isthmus conduction block for a typical atrial flutter ablation?
> 250 ms
<120 ms
≤20 ms
150 ms
> 150 ms
For either one of the current mapping systems, what color setting is used to distinguish healthy tissue during voltage mapping?
Purple
Red
Grey
White
Purple
During a tilt table test (TTT), the room should be_________.
Accompanied with staff to readily converse with patient for stimulation
Well–lit, with all lights on
Quiet with lights dimmed to establish a relaxing environment
Quiet with lights dimmed to establish a relaxing environment
The high/low filter setting for intracardiac electrograms is _________.
30/500 Hz
0.5/300 Hz
30/50 Hz
0.5/100 Hz
30/500 Hz
If a tachycardia cycle length is 600 milliseconds, what is its rate in beats per minute?
60 bpm
160 bpm
600 bpm
100 bpm
100 bpm
Activation mapping of a 3D electro-anatomical mapping system provides which of the following?
Displays border region of earliest tissue activation, shows early-meets-late patterns
Displays cardiac activation morphology for 12-lead comparison
Displays the dynamic propagation of an electrical activation wave front
Displays the voltage values according to a color spectrum
Displays border region of earliest tissue activation, shows early-meets-late patterns
During RF ablation, a high impedance reading continually shuts off the RF generator. The first troubleshooting attempt should be to:
Replace the RF catheter
Power down and restart RF generator
Check if the patient ground is secure
Replace the catheter connector
Check if the patient ground is secure
During monitoring of a radiofrequency ablation procedure, you observe the catheter temperature reach 100 degrees C. What is the next action?
Alert the physician and stop the ablation delivery because of potential coagulum
Alert the physician and stop the ablation delivery because an adequate lesion is achieved
Increase the impedance to decrease the wattage and subsequently the temperature
Increase the saline infusion rate of the fluid cooled ablation system
Alert the physician and stop the ablation delivery because of potential coagulum
The technologist is assisting the physician with a PVI. Midway through a burn, microbubbles appear on the ICE image. The technologist should:
Lower the power
Increase the power
Tell the physician to stop burning
Tell the physician to move the catheter
Tell the physician to stop burning
What is the usual result of moving the ground patch closer to the site of RF energy?
An increase in temperature
A decrease in temperature
An increase in impedance
A decrease in impedance
A decrease in impedance
One of the complications specific to PVI is:
Heart block
Thromboembolism
Cardiac tamponade
Atrioesophageal fistula
Atrioesophageal fistula
An impulse that blocks in the fast pathway and conducts through the slow pathway describes which of the following arrhythmias?
AVNRT
AVRT
WPW
Complete heart block
AVNRT
The mA of the stimulator is conventionally set at:
Half diastolic threshold
Diastolic threshold
2x diastolic threshold
3x diastolic threshold
2x diastolic threshold
A conduction impulse that initially blocks down the fast pathway and slowly conducts over the slow pathway to initiate a reentrant rhythm describes which arrhythmia?
Afib
AVRT
AVNRT
Accessory Pathway
AVNRT
AVNRT is a micro reentrant tachycardia.
TRUE
FALSE
True
When viewing a 12 lead ECG of AVNRT, the P-wave may not be present, if present it will occur after the QRS or be called a retrograde P-wave.
True
False
True
During AVNRT, ECG will display a tachycardia with a rate of
80-120 bpm
150-220 bpm
Greater than 300 bpm
150-220 bpm
To terminate AVNRT pharmacologically, what will be the initial dose of adenosine?
3 mg IVP
6 mg IVP
12 mg IVP
24 mg IVP
6 mg IVP
In typical AVNRT, which pathway will a premature beat initially block and then what pathway will the impulse propagate down?
Initially block down the fast pathway (FP), then propagate down the slow pathway (SP).
Initially block down the slow pathway (SP), then propagate down the fast pathway (FP).
Initially block down the fast pathway (FP), then propagate down the slow pathway (SP).
Conduction occurring down the slow AV nodal pathway and up the fast AV nodal pathway is
Typical AVNRT
Atypical AVNRT
Typical AVNRT
What non-pharmaceutical technique can also terminate AVNRT?
Carotid curling
Femoral curling
Carotid massage
Femoral massage
Carotid massage
A “jump” is defined during extra-stimulus pacing (S1S2) in which decrements of 10 ms on S2 demonstrates a jump in the A2H2 interval of >50ms, indicative of refractoriness in the fast AV nodal pathway.
TRUE
FALSE
TRUE
In AVNRT, what pacing technique typically reveals the presence of a “jump”?
Atrial burst pacing.
Decremental ventricular pacing.
Programmed atrial stimulation (A1 A2).
Pacing the atrium for 30 seconds.
Programmed atrial stimulation (A1 A2).
For an AVNRT ablation, the optimal ratio of atrial to ventricular intracardiac signal (A:V) displayed on the mapping/ablation catheter is
1:1
1:2
1:4
1:10
1:4
Slow junctional rhythm can be a normal finding during an AVNRT ablation.
TRUE
FALSE
TRUE
Currently, the fast pathway (FP) is routinely ablated for AVNRT ablation.
TRUE
FALSE
False
Anatomically, the slow pathway is commonly located in the
left atrial appendage.
right inferior pulmonary vein.
coronary sinus os to posterior septum.
zone of tissue along the tricuspid annulus posteroinferior to the node.
zone of tissue along the tricuspid annulus posteroinferior to the node.
Where is the fast pathway located?
CS os
Left atrial appendage
Right pulmonary vein
Superior to the triangle of Koch
Superior to the triangle of Koch
A beat that returns to its origin and is actually a single beat of reentrant tachycardia that failed to sustain AVNRT is known as _______________.
a fusion beat
a jump
an echo beat
triggered beat
an echo beat
AVNRT can be initiated with which of the following pacing maneuvers?
Atrial burst pacing.
Decremental ventricular pacing.
Pacing the atrium for 30 seconds.
Premature atrial pacing, also called extra-stimulus pacing.
Premature atrial pacing, also called extra-stimulus pacing.
What is the most common form of SVT?
AVRT
AVNRT
Wolff Parkinson White
Flutter
AVNRT
In AVRT, a delta wave is produced as a result of
Antegrade accessory pathway (AP) conduction which pre-excites ventricular tissue.
Retrograde accessory pathway (AP) conduction which pre-excites atrial tissue.
Antegrade AV Node conduction which pre-excites ventricular tissue.
Retrograde AV Node conduction which pre-excites atrial tissue.
Antegrade accessory pathway (AP) conduction which pre-excites ventricular tissue.
Which best describes a “manifest” accessory pathway (AP)?
Presence of a delta wave preceding the QRS complex surface ECG.
Normal conduction down the AV Node and then up the accessory pathway.
Conduction up the pathway or in the retrograde direction. (from V to A).
Presence of a delta wave preceding the QRS complex surface ECG.
An Accessory Pathway (AP) with antegrade conduction, displaying a pre-excited delta wave, is known as Wolff-Parkinson-White (WPW) syndrome.
TRUE
FALSE
TRUE
Concealed accessory pathways conduct both antegrade and retrograde conduction, resulting in short PR intervals.
TRUE
FALSE
FALSE
Orthodromic tachycardia is defined as
tachycardia with normal conduction down the AV node and then up the accessory pathway.
tachycardia in which the conduction travels down the accessory pathway and then up the AV node.
Initially block down the fast pathway (FP), then propagate down the slow pathway (SP).
Initially block down the slow pathway (SP), then propagate down the fast pathway (FP).
tachycardia with normal conduction down the AV node and then up the accessory pathway.
Antidromic tachycardia is defined as
tachycardia with normal conduction down the AV node and then up the accessory pathway.
tachycardia in which the conduction travels down the accessory pathway and then up the AV node.
Initially block down the fast pathway (FP), then propagate down the slow pathway (SP).
Initially block down the slow pathway (SP), then propagate down the fast pathway (FP).
tachycardia in which the conduction travels down the accessory pathway and then up the AV node.
During manifest activation, the delta wave will become more prominent as more of the ventricle is activated via the accessory pathway during rapid atrial pacing (burst pacing).
TRUE
FALSE
TRUE
If delta wave in V1 is negative on your 12 lead ECG, where is the accessory pathway located?
Right side
Left side
Indeterminate
Septum
Right side
AVRT is a _____________ circuit.
micro reentry
macro reentry
Triggered
micro automaticity
macro reentry
A Mahaim Fiber is a type of AP located similarly to the AV node on the tricuspid annulus and displays decremental properties, directly connecting to the fascicle of a bundle branch rather than the ventricle like the typical AV nodal accessory pathway.
TRUE
FALSE
TRUE
The following components are necessary to complete an AVRT circuit.
Atria, AV Node, AP
AP, AV Node, Ventricle
Atria, AV Node, Ventricle, AP
Atria, micro reentrant circuit, AV node, AP
Atria, AV Node, Ventricle, AP
In “orthodromic AVRT”, is the QRS complex narrow or wide?
Wide (pre-excited)
Narrow
Narrow
In “antidromic AVRT”, is the QRS complex narrow or wide?
Wide (pre-excited)
Narrow
Wide (pre-excited)
A patient in AVRT has a V-A time of 165 ms. The patient then develops a left bundle branch block (LBBB) and the V-A times jumps +50 ms, patient most likely has ________________.
right sided accessory pathway (AP)
left sided accessory pathway (AP)
atypical AVNRT
atypical flutter
left sided accessory pathway (AP)
The most common catheter position and sites when performing a diagnostic EP study for ventricular tachycardia (VT) are
HRA, HIS, LA
HRA, HIS, CA, LV, LVOT
HRA, HIS, CS
HRA, HIS, RVA, RVOT
HRA, HIS, RVA, RVOT
Damaged cardiac tissue as a result of diminished or no blood supply describes which type of cardiac disease tissue?
Idiopathic
Ischemic
Ischemic
This is the most common site for idiopathic VT is the
LVOT.
RVA.
aortic cusp.
RVOT
VT is considered “sustained” when it is maintained for
3 beats
5 beats
15 sec
30 sec
30 sec
If a patient has VT and is shocked at 22 seconds because the patient is hemodynamically unstable, the VT is considered sustained.
TRUE
FALSE
True
This chamber is the most susceptible to ischemic, scar based VT’s
RV
LV
Equal
LV
The condition where fatty tissue infiltrates or fibrous tissue replaces normal myocardial tissue of the RV is known as
Long QT syndrome (LQTS)
Brugada syndrome
Idiopathic dilated cardiomyopathy (ILVT)
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Which of the following are reentrant criteria for reentrant VT?
conduction around an in-excitable obstacle
zone of slow conduction
pathway of unidirectional block
All are correct
All are correct
This is a genetic disorder that affects the ion channels (sodium, potassium) of cardiac cells and can result in an arrhythmia called torsade’s de points
Long QT syndrome (LQTS)
Brugada syndrome
Idiopathic dilated cardiomyopathy (ILVT)
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Long QT syndrome (LQTS)
These devices have been proven to reduce mortality of selected patients at risk for sudden cardiac death is
Permanent pacemaker (PPM)
Bi-ventricular pacemaker (Bi-V)
Implantable cardioverter-defibrillators (ICD’s)
Loop recorder
Implantable cardioverter-defibrillators (ICD’s)
Patients with Brugada syndrome will usually present with a right bundle branch block (RBBB).
TRUE
FALSE
TRUE
Patients with Brugada syndrome will present with subtle ST segment elevation in
II, II, AVF
V1-V3
II, AVF
V3-V5
V1-V3
The interval of time in milliseconds (ms) between two cardiac electrical stimuli or paced beats is known as
Cycle length
Coupling interval
Capture
Coupling interval
A drive train has a series of 6-8 paced beats at a fixed cycle length is considered known as
S1
S2
S3
S4
S1
When evaluating the sinus node function, an abnormal CSNRT value would be
275 ms
375 ms
475 ms
575 ms
575 ms
SNRT assessment is performed by
pacing the atrium for 30 sec and measuring last paced “A” to first intrinsic “A”.
pacing the atrium for 3 sec and measuring last paced “A” to first intrinsic “A”.
S1 drive train pacing for 90 sec, add S2 and measuring the last paced S2 to first intrinsic “A”.
S1 drive train pacing for 90 sec, add S2 and measuring last paced S2 to first intrinsic “V”.
pacing the atrium for 30 sec and measuring last paced “A” to first intrinsic “A”.
H-V conduction interval of 23 ms is considered a normal value.
True
False
False
The longest coupling interval of a premature stimulus which does not conduct through to the AV node is known as
AERP
AVNERP
VERP
VAERP
AVNERP
The longest coupling interval for a premature stimulus which does not conduct to depolarize ventricular tissue.
AERP
AVNERP
VERP
VAERP
VERP
Normal H-V conduction interval is
15 - 25 ms
35 - 55 ms
75 - 95 ms
100-120 ms
35 - 55 ms
Electrical stimuli that causes depolarization of the chamber being stimulated is known as
capture.
threshold.
sensitivity.
chronaxie.
capture
The minimum current needed to capture a chamber with pacing stimulus is known as
capture.
threshold.
sensitivity.
chronaxie.
threshold.
When incremental burst pacing (S1) faster until loss of 1:1 ratio in AV conduction is noted, the longest S1 coupling interval that fails to conduct 1:1 is known as which of the following?
SACT
SNRT
CSNRT
Wenckebach
Wenckebach
Burst pacing is _____________________.
introduction of one or more premature paced beats (extra-stimulus) at a shorter cycle length after the proceeding pacing train which is a fixed cycle length
pacing while adjusting the cycle length in small increments (10-50 ms)
pacing at a fixed cycle length
all are correct
pacing at a fixed cycle length
Introduction of one or more premature paced beats (extra-stimulus) at a shorter cycle length after the proceeding pacing train which is a fixed cycle length (S1, S2), is which type of pacing?
Burst
Decremental
Incremental
Programmed Extra-Stimulus (PES)
Programmed Extra-Stimulus (PES)
When burst pacing the RVA via an EP catheter, the pacing output should be set to at least _____________________.
less than 0.5 mA
less than 1.0 mA
0.5 more than threshold determination
1.0 mA more than threshold determination
1.0 mA more than threshold determination
What condition may lead to complete heart block while advancing an EP catheter to the right ventricular apex?
Right bundle branch block (RBBB)
Left bundle branch block (LBBB)
Right sided accessory pathway (AP)
Left sided accessory pathway (AP)
Left bundle branch block (LBBB)
RV pacing with proper capture produces an ECG morphology resembling__________________.
right bundle branch block (RBBB)
Left bundle branch block (LBBB)
polymorphic ventricular tachycardia
tri-fascicular block
Left bundle branch block (LBBB)
When performing threshold determination, stimulus output is conventionally set to a minimum of at least 3 mA or:
1 mA
the point of tissue capture
2x threshold minimum
3x threshold minimum
2x threshold minimum
A typical drive train consists of
1 beat
4 beats
8 beats
12 beats
8 beats
Ventricular arrhythmia induction is assessed with
incremental pacing.
decremental pacing
burst pacing.
PES pacing.
PES pacing.
Dual AV node physiology is assessed with
incremental pacing.
decremental pacing
burst pacing.
PES pacing.
PES pacing.
Atrial tachycardias may be difficult to initiate, however the most effective pacing maneuver is
incremental pacing.
burst or decremental pacing.
PES pacing.
burst or decremental pacing.
What should the next step be in trouble shooting when the ablation generator shuts off with a ‘high impedance’ error message?
Replace the ablation cable.
Replace the ablation catheter.
Restart the EP recording system.
Ensure the grounding pad is properly applied to the patient.
Ensure the grounding pad is properly applied to the patient.
When performing an ablation with an open irrigated ablation catheter, what must be done when the irrigation pump alarms?
Stop the pump and flush bolus flush the pump at 30 cc/minute.
Titrate the irrigation rate to 8cc from 15cc on the irrigation pump.
Reset the alarm parameter on the irrigation pump.
Stop the pump and notify the performing physician.
Stop the pump and notify the performing physician.
What is the primary cause of temperatures observed over 100 degrees Celsius during radio-frequency ablation?
Resistive heating
Conductive heating
Catheter tip coagulum & char
Excessive irrigation rate
Catheter tip coagulum & char
The common tip size for a Cryoablation catheter tip is:
4 mm
6 mm
8 mm
10 mm
4 mm
If bubbles are observed on intra-cardiac ultrasound (ICE) during left sided ablation, the EP staff should:
Stop the pump and flush bolus flush the pump at 30 cc/minute.
Titrate the irrigation rate to 8cc from 15cc on the irrigation pump.
Reset the alarm parameter on the irrigation pump.
Stop the pump and notify the performing physician.
Stop the pump and notify the performing physician.
What is the next step if a patient ‘s rhythm changes to complete heart block during ablation near the His bundle?
Stop the ablation.
Stop ablation and wait for normal conduction to begin before resuming ablation.
Start ventricular pacing or prep for temporary pacing.
Stop ablation and start ventricular pacing or prep for temporary pacing.
Stop ablation and start ventricular pacing or prep for temporary pacing.
An effective lesion formation during radio-frequency ablation (RFA) is marked by:
Decrease in impedance, 5-10 ohms.
Increase in impedance, 5-10 ohms.
No change in impedance.
Moving the grounding pad closer to the heart will likely result in:
Decrease in impedance, 5-10 ohms.
Moving the grounding pad closer to the heart will likely result in:
Decrease in impedance (ohms).
Increase in impedance (ohms).
Decrease in temperature (Celsius)
Increase in temperature (Celsius)
Decrease in impedance (ohms).
A severe complication to left atrial ablation that is often monitored for is:
Esophageal fistula
Thromboembolism
Cardiac tamponade
Complete heart block
Esophageal fistula
Which of the following determines the size of the myocardial lesion during ablation?
Impedance
The location of the indifferent electrode (grounding patch)
The size of the distal electrode & the amount of energy delivered
All are correct
The size of the distal electrode & the amount of energy delivered
A successful endpoint for a ‘typical’ isthmus dependent atrial flutter ablation, is an increase in the trans-isthmus conduction post pacing interval (PPI) of at least:
10 ms
100 ms
150 ms
250 ms
150 ms
What situation would require the use of a 10-mm tip and / or high-output 100-watt generator for ablation?
Slow pathway ablation in AV Node modification.
Creating a lesion on the posterior left atrial wall.
When a larger myocardial lesion is desired, i.e. thicker tissue like the isthmus and ventricular tissues.
Atrial fibrillation ablation.
When a larger myocardial lesion is desired, i.e. thicker tissue like the isthmus and ventricular tissues.
In a ‘typical’ atrial flutter (AFL) case, post ablation endpoint must prove
the septum is now no longer part of the circuit.
the flutter cycle length is now slower.
the flutter is now atypical.
bidirectional block has occurred across the area where ablation was performed.
bidirectional block has occurred across the area where ablation was performed.
What nerve should be considered when ablating the lateral regions of the right heart?
Phrenic Nerve
Vagus Nerve
Trigeminal Nerve
Diaphragmatic Nerve
Phrenic Nerve
All of the following are ultrasound modalities EXCEPT
TTE
TEE
EFT
ICE
EFT
Which type of ultrasound can be done the same day without need for sedatives?
TTE
TEE
EFT
ICE
TTE
Intracardiac Echo (ICE) is usually introduced to the heart via the
esophagus.
internal jugular vein.
femoral artery.
femoral vein.
femoral vein
The functional part of an ultrasound probe is the referred to as the
Oscillator
Anode
Rotor
Transducer
Transducer
Positioning the ICE catheter in the RA, just above the terminal end of the IVC, with the transducer oriented with a leftward-anterior transducer face yields which of the following views?
Home view
Lateral view
RVOT view
Transeptal view
Home view
After insertion of the ICE imaging catheter, which maneuver sets up imaging for transseptal access?
clockwise rotation from home view
counterclockwise rotation from home view
clockwise rotation from home view
Visual presentation of ultrasound in which the depth of echo is displayed along one axis and time is displayed along a second axis, recording ‘motion’ of interfaces away and towards the transducer is known as
Doppler
3D Doppler
M-Mode
Axis Mode
M-Mode
The technology of ultrasound using the high frequency sound waves to image, measure and calculate blood flow is known as
Doppler
3D Doppler
M-Mode
Axis Mode
Doppler
Aspiration is a usual complication of which type of ultrasound modality?
TTE
TEE
EFT
ICE
TEE
During afib ablations, ICE is used to visualize all of the following EXCEPT
Blood flow velocities
Ejection fraction
Guiding transseptal puncture
Identification of procedural complications
Ejection fraction
The following systems are 3D mapping systems EXCEPT:
Hansen
Carto
Rhythmia
LocaLisa
Hansen
3D electro-anatomical mapping systems display a variety of unique mapping techniques that include
voltage mapping
activation mapping
propagation mapping
All the above
All the above
In voltage mapping, voltage values of <1.5 mV is considered abnormal cardiac tissue, and values <0.5 mV is considered
Propagation
Activation
Scar
All the above
Scar
On the CARTO mapping system, low voltage will be depicted in which color?
Red
Purple
Blue
White
Red
The technique that utilizes a recorded ECG/EGM of a cardiac activation morphology generated by an arrhythmia to be compared against paced activation morphologies in attempts to reproduce and match morphologies, which identifies the origin of the arrhythmia is known as
Entrainment mapping
activation mapping
propagation mapping
pace mapping
pace mapping
The mapping technique that requires the advancement of the tachycardia rate to that of the paced cycle length without altering the morphology of the tachycardia is
entrainment mapping
activation mapping
propagation mapping
pace mapping
pace mapping
What is the corrected QT (QTc) for a patient with a QT of 300 ms and R-R interval of 750 ms?
0.3
0.35
0.41
2.5
0.35
What is the heart rate (HR) of a sinus cycle length at 800ms?
65 bpm
72 bpm
75 bpm
80 bpm
75 bpm
What is the corrected sinus node recovery time (cSNRT) for a sinus node recovery time measured at 1395 ms and a sinus cycle length measured at 775ms?
620 ms
675 ms
2170 ms
2945 ms
620 ms
What is the formula to calculate corrected sinus node recovery time (cSNRT)?
SNRT – SCL
SNRT - SCL/2
SCL + SNRT
SCL - PPI/2
SNRT – SCL
A SNRT is 1450 MS. The Sinus Cycle length is 850 ms. What is the CSNRT?
320 ms
600 ms
750 ms
1200 ms
600 ms
Which of the following is Ohms Law?
V= IR
I=VR
V=R/I
V= I/R
V= IR
Which of the following is not a correct expression of Ohms Law?
V= IR
R= V/I
I= V/R
V= I/R
V= I/R
What is the cycle length of a beat of a patient with a heart rate (HR) of 150 bpm?
150 ms
250 ms
400 ms
1500 ms
400 ms
What are common high/low pass filter settings for SURFACE lead ECGs of a typical EP recording system?
0.5-100Hz
30-50 Hz
30-500 Hz
0.5-300 Hz
0.5-100Hz
What are common high/low pass filter settings for INTRACARDIAC electrograms (EGMs) of a typical EP recording system?
0.5-100Hz
30-50 Hz
30-500 Hz
0.5-300 Hz
30-500 Hz
Which of the following best describes Low amplitude/frequency?
Cardiac tissue re-polarizations, which are displayed and represented by long and dull signal frequencies and deflections.
Cardiac tissue depolarizations displayed and represented by sharp and discrete signal frequencies and deflections.
A measure of desired signal compared to the level of background noise expressed in a ratio.
Cardiac tissue re-polarizations, which are displayed and represented by long and dull signal frequencies and deflections.
The filter setting that eliminates signal below a set frequency threshold or cut-off, allowing high frequencies to pass through the set cut off is which of the following?
Notch filter
Clipping
High band pass filter
Low band pass filter
High band pass filter
The limiting of EGM signal amplitude (positive & negative), reducing signal overlapping of EGM’s is best achieved by which of the following?
Notch filter
Clipping
High band pass filter
Low band pass filter
Clipping
Which of the following filters eliminates electronic signal noise of 60 Hz that is inherent in North American alternating current?
Notch filter
Clipping
High band pass filter
Low band pass filter
Notch filter
Typical High Pass EP recording system filtering is generally set at which values?
0.5-100 Hz
30-50 Hz
100-300 Hz
300-500 Hz
30-50 Hz
Typical Low Pass EP recording system filtering is generally set at which values?
0.5-100 Hz
30-50 Hz
100-300 Hz
300-500 Hz
300-500 Hz
Far-field signals are EGM signals recorded from localized tissue in contact between two catheter electrode pairs, displaying a narrow and sharp signal deflections.
TRUE
FALSE
FALSE
EGM signals recorded from localized tissue in contact between two catheter electrode pairs, displaying a narrow and sharp signal deflections is best described as which of the following?
Near-field
Far-field
Low amplitude/frequency
High amplitude/frequency
Near-field
Which of the following indications would LEAST likely result in a pacemaker?
Complete Heart Block
Sinus Bradycardia
Symptomatic Mobitz Type I
Symptomatic Mobitz Type II
Sinus Bradycardia
The physician is using the laser to extract an RV pacing lead with he notices a snowplowing effect. The BEST next step would be to
Upsize the laser sheath by one French size
Downsize the laser sheath by one French size
Try a Byrd workstation from the groin
Take out laser sheath and apply more traction to the locking stylet
Incorrect
Upsize the laser sheath by one French size
Cellular telephones:
Never inhibit pacing
May be carried in the contralateral breast pocket
Cause greater interference in bipolar pacing systems
Will permanently damage pacemakers if held in close proximity to the device
May be carried in the contralateral breast pocket
Pacing thresholds are not influenced by:
Maturation process
Electrode material
Electrode surface area
Insulation material
Insulation material
Lead conductor fracture typically results in:
Low impedance
High impedance
Increased sensitivity
Decreased sensitivity
High impedance
Resistance is measured in:
Amperes
Volts
Millivolts
Ohms
Ohms
The patient arriving for their pacemaker implant is complaining of itching and feeling warm. The IV Ancef was started by the floor nurse approximately 20 minutes ago. What immediate action should be taken?
Notify the physician immediately
Give 50 mg IV Diphenhydramine
Stop the Ancef drip and notify the physician
Do nothing until the physician arrives
Stop the Ancef drip and notify the physician
A pacemaker would be necessitated for a patient with:
Mobitz Type I heart block at 120 BPM
Symptomatic 1st degree heart block with HIS purkinje disease
Wenckeback block at 380 msec
Syncope in the setting of hypovolemia
Symptomatic 1st degree heart block with HIS purkinje disease
At the time of implant, the atrial sensing threshold should be at least _____ mV.
0.5
1.0
1.5
2.0
0.5
Magnet application to an internal cardiac defibrillator closes the Reed switch which disables:
Pacing
Pacing and shocking therapies
Arrhythmia detection
Shocking therapies
Shocking therapies
Which of the following is the MOST important consideration when selecting a sit for a peripheral IV in a patient undergoing a device impant?
Patient preference
Length of hospital stay
Planned side of implant
Type of intravenous fluid
Planned side of implant
A properly functioning RV apical pacing lead should produce a _____ morphology on the surface ECG.
LBBB
RBBB
Bi-fasicular block
Tri-fasicular block
LBBB
While providing patient education post-pacer implant, signs of pacemaker malfunction should include:
Dizziness, dyspnea, angina, peripheral edema, return of previous symptoms
Dizziness, palpitations, dyspnea, dysphagia
Syncope, muscle twitch, redness around pacemaker pocket
Syncope, angina, shortness of breath, hyperventilation, hiccoughs
Syncope, angina, shortness of breath, hyperventilation, hiccoughs
Which of the following safety checks should be performed prior to using a temporary pacemaker for pacing?
Threshold checks should be done
The pacemaker should be gas sterilized
Check date of last battery change
Terminal pins should be checked by an ohm meter
Check date of last battery change
What effect describes the fact that the pacing threshold is usually lower when measured by gradually decrementing stimulus output instead of increasing stimulus output for lead threshold testing?
Wedensky
Hysteresis
Bernoulli
Chronaxie
Wedensky
Which impedance value of a newly implanted RV lead is considered a normal value?
100 Ω
200 Ω
700 Ω
1700 Ω
700 Ω
When testing a right ventricular (RV) lead implanted in the right ventricular apex, stimulation of the RV by the RV lead will resemble which of the following morphology patterns on ECG?
Narrow QRS with U-wave
Right bundle branch block (RBBB)
Left bundle branch block (LBBB)
Ventricular ectopic beats (VEBs)
Left bundle branch block (LBBB)
After failed DFT testing from subsequent RV lead repositioning, the MOST appropriate next step is:
Set a higher DFT
Enable both burst and ramp ATP pacing
Increase the atrial sensing crosstalk
Reverse shocking polarity
Reverse shocking polarity
Prior to using a temporary pacemaker, what should be checked first?
Battery indicator status
Date of last check
Whether it is in synchronous or asynchronous pacing mode
Compatibility with pacing cables
Date of last check
In preparing for a new ICD device implant, which vessel has a greatest risk of pneumothorax when obtaining vascular access?
Subclavian
Jugular
Axillary
Cephalic
Subclavian
During a pulse generator replacement procedure for ERI, you notice that one RV lead is capped with sutures and another RV lead is securely connected to the device header. What is the next appropriate step?
Proceed with the generator change as normal
Uncap the RV lead and test sensing and threshold
Uncap the RV lead, disconnect the other RV lead, and test both
All are correct answers
Proceed with the generator change as normal
When preparing to perform a lead extraction procedure for a chronic lead, which of the following is the MOST critical?
Surgical team standby
Temporary pacemaker setup
Pericardiocentesis tray
Thoracotomy tray
Surgical team standby
In switching a temporary pacemaker from demand mode to asynchronous mode, what adjustment is made?
Decreased sensitivity
Increased sensitivity
Decreased threshold
Increased threshold
Increased sensitivity
After the right ventricular (RV) lead is positioned and fixated, what is next?
Conduct threshold determination again
Irrigate the pocket
Suture the proximal portion of the RV lead into the device pocket
Connect the RV lead to the device header
Conduct threshold determination again
What is the first thing an RN/Technologist should do before handing the laser lead over to the performing physician?
Calibrate the laser machine
Angle the protective lead shield to 45 degrees
Up-size the sheath
Secure the locking stylet
Calibrate the laser machine
Impedance (resistance) is measured in which value?
Volts
Ohms
mA
Watts
Ohms
What statement describes threshold of a device implant lead?
The minimum number of milliseconds (ms) required to elicit a response from the chamber paced.
The maximum number of ohms required to elicit a response from the chamber paced.
The minimum amount of mA required to elicit a response from the chamber paced.
The maximum amount of mA required to elicit a response from the chamber paced.
The minimum amount of mA required to elicit a response from the chamber paced.
Which is the most appropriate protocol for testing the capture threshold of a newly implant atrial lead?
Decrease pulse voltage from 5V until loss of capture.
Increase the pulse width from 0.5ms until capture.
Increase pulse voltage from 0.5V until capture.
Decrease the pulse width from 1.5ms until loss of capture.
Decrease pulse voltage from 5V until loss of capture.
Which statement best describes “sensing” of a pacemaker?
Pulse amplitude, or height (measured in mV) and its pulse duration or width (measured in ms).?
The point at which twice the voltage value meets the strength duration curve, providing a safety margin for capture.
The point at which the plateau begins and roughly establishes the minimum voltage requirements to capture the heart.
The device’s ability to recognize the intrinsic conduction from the patient’s heart.
The device’s ability to recognize the intrinsic conduction from the patient’s heart.
Which of the following statements best describes “chronaxie” of the strength duration curve?
Pulse amplitude, or height (measured in mV) and its pulse duration or width (measured in ms).?
The point at which twice the voltage value meets the strength duration curve, providing a safety margin for capture.
The point at which the plateau begins and roughly establishes the minimum voltage requirements to capture the heart.
The device’s ability to recognize the intrinsic conduction from the patient’s heart.
The point at which twice the voltage value meets the strength duration curve, providing a safety margin for capture.
Capture is simply described as cardiac endocardium depolarization in response to electrical energy from the pulse generator.
TRUE
FALSE
TRUE
Which feature triggers rate algorithms to increase pacing rate to accommodate for physical demand?
Magnetic Ball Sensor
Minute Ventilation Sensor
Hysteresis
Piezoelectric Crystals Sensor
Piezoelectric Crystals Sensor
End of Life (EOL) of a lithium-iodine pacemaker battery is considered once the battery reaches which one of the voltage values?
1.2 V
1.8 V
2.8 V
3.2 V
1.8 V
Which of the following is NOT programmable in a pacemaker?
Sensitivity
Pulse width
Lead polarity
Refractory periods
Refractory periods
Which of the following has NO effect on ‘pacing thresholds’?
steroid tip lead
type of lead insulation material
lead tissue contact
lead insulation break
type of lead insulation material
Low impedance of a device lead during follow up in a pacemaker clinic most likely is a result of:
normal values
insulation break
lead fracture
device ERI
insulation break
A lead fracture should be suspected of a device implant lead with an impedance increase of ____________________.
100 ohms
200 ohms
1000 ohms
1200 ohms
1000 ohms
Normal lead impedance range is:
0.05 - 1.5
30 - 50
50 - 500
300 - 1500
300 - 1500
On a pacemaker dependent patient, why would NO pacing occur while the device is out of the pocket even though ALL leads are correctly connected to the device generator?
The device is unipolar.
The pulse width is set as 2.0ms.
The device is bipolar.
The pulse width is set as 2.5ms
The device is unipolar.
In an acutely implanted pacemaker, ideal atrial sensing values should be at least _______________.
0.5mV
1.0mV
1.6mV
3.6mV
1.6mV
Bipolar pacemaker leads can NOT be programmed as a unipolar lead.
TRUE
FALSE
FALSE
What is the normal lead impedance range for a newly inserted typical right atrial lead?
100 - 200 Ω (ohms)
300 - 500 Ω (ohms)
300 - 1,500 Ω (ohms)
900 - 2,000 Ω (ohms)
300 - 1,500 Ω (ohms)
During the lead maturation process, what happens to the implanted lead?
Lead sensitivity will decrease below 1.5mV.
Insulation is prone to lead fracture.
Threshold values decrease below level of implant (non-steroid).
Impedance increases as the fibrotic capsule forms, and then levels out as the lead matures.
Impedance increases as the fibrotic capsule forms, and then levels out as the lead matures.
The ideal Sensitivity setting for the right atrium is
0.5 - 1 mV
2 - 3 mV
4 - 40 mV
15 - 20 mV
2 - 3 mV
Select the adjustment that will change a temporary pacemaker from demand to asynchronous mode.
Increased sensitivity
Decreased sensitivity
Increased mA
Decreased mA
Decreased sensitivity
Pacing from a RV lead positioned at the apex will produce a morphology similar to
RBBB
LBBB
VF
Bigeminy
LBBB
The ideal Sensitivity setting for the right ventricle is
0.5 - 1 mV
2 - 3 mV
4 - 40 mV
15 - 20 mV
4 - 40 mV
Hysteresis is a programmable rate utilized to do which of the following?
Therapy to treat SVT’s and VT’s.
Synchrony of a dual lead pacemaker.
Initiate overdrive pacing.
Promote intrinsic pacing.
Promote intrinsic pacing.
Which scenario is MOST likely to necessitate a pacemaker?
Syncope induced by orthostatic hypotension.
Non-Symptomatic, Wenckebach, 45 bpm.
Symptomatic, 1st degree heart block, 42 bpm.
Non-symptomatic Mobitz I, 47 bpm.
Symptomatic, 1st degree heart block, 42 bpm.
Which scenario is LEAST likely to necessitate a pacemaker?
Sinus bradycardia
3rd degree heart block
Symptomatic, 1st degree heart block, 42 bpm
Symptomatic Mobitz I, 47 bpm
Sinus bradycardia
A device feature of pacing to terminate an arrhythmia prior to defibrillation is known as
Detection
DFT
NIPS
ATP
ATP
Determining the number of joules necessary to successfully terminate VT/VF mentioned utilizing the patients implanted device is known as
Detection
DFT
NIPS
ATP
DFT
The feature of rapid pacing at progressively shorter intervals during ATP is known as
Incremental pacing
PES
Burst pacing
Ramp pacing
Ramp pacing
Prior to utilizing a temporary pacemaker, what safety check must be performed?
Date of last battery change.
Sync vs Demand mode setting.
Sterility of temporary pacing cables.
Ohm rating.
Date of last battery change.
Which of the following features describes a programmable rate that devices use to promote intrinsic pacing?
Magnetic Ball Sensor
Minute Ventilation Sensor
Hysteresis
Piezoelectric Crystals Sensor
Hysteresis
The first letter of the NBG code
describes the rate modulation of the device.
describes the response by device to a sensed event.
represents the chamber or chambers in which the device senses or detects signals.
represents the chamber or chambers that are paced by the device.
represents the chamber or chambers that are paced by the device.
The second letter of the NBG code
describes the rate modulation of the device.
describes the response by device to a sensed event.
represents the chamber or chambers in which the device senses or detects signals.
represents the chamber or chambers that are paced by the device.
represents the chamber or chambers in which the device senses or detects signals.
The third letter of the NBG code
describes the rate modulation of the device.
describes the response by device to a sensed event.
represents the chamber or chambers in which the device senses or detects signals.
represents the chamber or chambers that are paced by the device.?
describes the response by device to a sensed event.
“O” of the NBG code indicates
None
Single
Inhibited
Triggered
None
“I” of the NBG code indicates
None
Single
Inhibited
Triggered
Inhibited
Which mode represents asynchronous ventricular pacing with no sensing.
AAI
VOO
DDI
DDD
VOO
Which mode represents dual chamber pacing & sensing?
AAI
VOO
DDI
DDD
DDD
After an ICD implant, when may the patient may resume normal exercise?
after 24 hours
after 72 hours
in one week
as their physician advises
as their physician advises
According to the FDA, education on cell phone use with pacemaker patients must state that:
Cellphones have no effect on pacemakers.
Smart phones may trigger DOO mode.
Place the cell phone in their pocket opposite to the side of the implanted device and hold the cell phone to hear on the opposite side of the implanted device.
Smart phones interfere with bipolar pacing configurations.
Place the cell phone in their pocket opposite to the side of the implanted device and hold the cell phone to hear on the opposite side of the implanted device.
A patient complains of feeling ‘hot and itchy’ after receiving 15 min. of antibiotic IV therapy. What is the most appropriate next step?
Decrease the IV infusion rate to 1/2.
Increase the IV infusion rate 50% of initial infusion rate.
Notify the performing MD.
Stop the IV infusion and notify the performing MD.
Stop the IV infusion and notify the performing MD.
What diagnostic exam should be ordered after a device implant utilizing a subclavian vein puncture for vessel access?
Chest x-ray
Echocardiogram
ACT
INR
Chest x-ray
The technology that allows an ICD to have it shocking therapies disabled when a magnet is applied is the
Minute ventilation sensor
Reed switch
Magnetic ball sensor
Piezoelectric crystals sensor
Reed switch
In pre-op prep of a patient undergoing an ICD implant, what is the primary consideration of an IV site placement?
Type of antibiotic allergy.
Length of expected procedure duration.
Type of antibiotic medication administered pre-operatively.
Side of device implantation.
Side of device implantation.
Signs of an improperly functioning pacemaker immediately after the procedure would be:
Dizziness, palpitations, redness at IV site.
Dizziness, angina & shortness of breath.
Syncope, redness around implant site, diaphragmatic stimulation.
Syncope, hives on the patient’s chest, muscles twitch.
Dizziness, angina & shortness of breath.
This approach requires a more surgical skill since this technique calls for deeper cutting and separation of the fascia and muscles in order to directly identify and isolate the vessel for direct access.
Seldinger
Cutdown
Subclavian
Axillary
Cutdown
This method is where the vein is accessed only once, by the one access stick from the needle, and the introducer sheath is inserted over the guide wire and into the vessel. The dilator of the sheet is removed and a second guide wire is placed into the sheath. Then the sheath is removed, freely exposing the guide wires.
2 Sticks
Stick, retain guide wire
1 stick, 2 guide wire
1 Stick, 1 guide wire
1 stick, 2 guide wire
Which sutures are absorbable?
Ehticon
Monocryl
Vicryl
Both Monocryl and Vicryl
Both Monocryl and Vicryl
Absorbable sutures are normally absorbed into the patient’s tissues between
3 – 5 days
7 – 14 days
30 – 60 days
90 – 120 days
90 – 120 days
Post device implant instructions typically include which of the following?
No lifting for 14 days
Keep incision site dry for 48 hours
No driving for 72 hours
All are correct answers
All are correct answers
Signs of pacemaker malfunction may include
Dizziness
Palpitations
Shortness of breath (SOB)
All are correct answers
All are correct answers
Cell phones are capable of producing electro-magnetic interference (EMI) and may have an effect on the pacemaker if the mobile phone is in close proximity to the implanted device.
TRUE
FALSE
TRUE
Before using the laser lead sheath for lead extraction, which item should be utilized first for lead removal?
Locking stylet
Stepwise sheath
Stepwise stylet
Suture basket
Locking stylet
During a laser lead extraction procedure, the physician encounters a ‘snowplowing’ effect. The most appropriate step is
Pull harder on the stylet.
Use a stepwise sheath.
Downsize laser sheath.
Upsize the laser sheath.
Upsize the laser sheath.
The best source for correctly sourcing the proper laser sheath size for a specific lead size will be
Device lead manufacturer
Device lead rep
Referring physician
SLS Reference Guide
SLS Reference Guide
All of the following are Class I indications for trans-venous lead extraction except:
52 yr. old male with definite ICD system infection.
Non-functioning lead in female adolescent.
Life threatening arrhythmias secondary to retained lead fragment.
Patient with clinically significant thromboembolic events associated with thrombus.
Non-functioning lead in female adolescent.
Class I recommendations for the extraction of chronic pacing and defibrillation leads include all of the following EXCEPT:
Life threatening arrhythmias due to a retained lead fragment
A lead that interferes with the treatment of a malignancy
Non functional leads in a young patient
An occult infection for which no source can be found and for which the pacing system is suspected
Non functional leads in a young patient
Just prior to using the laser sheath for lead extraction, a _____ should be used first to attempt removal.
Manufacturer’s stylet
Locking stylet
Byrd suture
Ligature tie
Locking stylet
All of the following functions are programmable in both VVI and DDD pacemakers EXCEPT:
Sensitivity
Sensitivity
Refractory periods
Voltage output
Refractory periods
What does a low impedance reading mean during a follow up visit post pacemaker implant?
Possible lead dislodgeme
Possible lead insulation break
Normal pacemaker function
Normal fluctuations are expected
Possible lead insulation break
ICD conductor fracture should be suspected when there is an impedance increase of:
250 ohms
500 ohms
1000 ohms
1500 ohms
1000 ohms
Hysteresis is used to:
Prevent intrinsic conduction
Promote intrinsic conduction
Promote atrial pacing
Promote ventricular pacing
Promote intrinsic conduction
Which of the following BEST describes the threshold for a single chamber implantable pacemaker?
The minimum amount of mA required to elicit a response from the chamber paced
The maximum amount of mA to block the normal sinus rate
The amount of time between pacemaker discharge cycles
The minimum amount of voltage to overdrive the normal sinus rate
The minimum amount of mA required to elicit a response from the chamber paced
Which of the following tests should be ordered after subclavian venous puncture?
Bloodwork
Electocardiogram
Echocardiography
Chest X-ray
Chest X-ray
A patient presents with an infected ICD pocket. To prepare for a laser lead extraction, the BEST source to find lead sizing information for a laser sheath is the:
SLS reference
Device Clinic
Lead manufacturer
Physician
SLS reference
Which of the following is likely to happen during the lead maturation process?
Insulation fracture
Electrode surface deterioration
Decrease in threshold, to a level below that of implant
Encapsulation of the electrode with fibrin tissue
Encapsulation of the electrode with fibrin tissue
Which of the following best describes the appropriate protocol for testing the pacing capture threshold of a newly implanted lead?
Increasing the pulse width from 0.1 msec until capture is achieved
Increasing the pulse voltage from 0.01 msec until capture is achieved
Decreasing the pulse voltage from 5 volts until capture is lost
Decreasing the pulse width from 2 msec until capture is lost
Decreasing the pulse voltage from 5 volts until capture is lost
The normal range for pacemaker lead impedance is _____ ohms.
15-30
50-100
100-500
300-1200
300-1200
While assisting with a pacemaker generator change on a pacemaker-dependent patient, the doctor attaches the new generator to the leads but no pacing occurs until the generator is placed in the pocket. This happened because:
The leads are reversed in the header
It is a unipolar configuration
It is a bipolar configuration
The pacing threshold is high
It is a unipolar configuration
Patients recently receiving internal cardiac defibrillators are instructed that they may drive a car after:
They receive the lambs wool seat belt pad
The first telephone pacemaker check
They obtain their device identification card
Their physician advises them
Their physician advises them
At the time of a dual pacemaker implant, the sensing threshold for the atrium must be at least which of the following?
0.5 mV
1.5 mV
5.0 mV
7.0 mV
1.5 mV
Current of injury (COI) is often experienced in an implantable cardioverter defibrillator (ICD) implant and attributed to which of the following?
Atrial passive fixation
Ventricular active fixation
Anti-tachycardia pacing (ATP)
Defibrillation threshold (DFT)
Correct
ATP
What device polarity configuration uses the patient’s body to complete the pacemaker circuit?
Unipolar
Bipolar
Biventricular
Biphasic
Unipolar
After permanent pacemaker implant, a patient is evaluated by the device representative, registering the RV lead impedance at 100 Ω and 7.0mV. The RV lead reading suggests:
Normal expected parameters for an acute lead
RV lead insulation break
RV lead wire fracture
RV lead dislodgement
RV lead insulation break
During the insertion of a biventricular implant device, the right ventricular (RV) lead is commonly inserted prior to which of the following other leads?
Right atrial (RA) lead
Left ventricular (LV) lead
Subcutaneous left ventricular (LV) lead
Both B & C
Left ventricular (LV) lead
Placing a magnet over an implanted ICD device will result in which of the following?
Enable to asynchronous VOO pacing
Disable arrhythmia detection
Suspend tachyarrhythmia therapies
Both Disable arrhythmia detection and Suspend tachyarrhythmia therapies are correct
Both Disable arrhythmia detection and Suspend tachyarrhythmia therapies are correct
Which of the following conditions causes device lead dislodgment after device implant?
Wedensky effect
Pacemaker syndrome
Chronaxie
Twiddler’s syndrome
Twiddler’s syndrome
After the device implant pocket is ready for pocket closure, what is the correct closure order of layers to be sutured?
Muscle, epidermis, dermis
Muscle, subcutaneous, epidermis
Subcutaneous, epidermis, dermis
Subcutaneous, dermis, epidermis
Subcutaneous, dermis, epidermis
Ohm’s law is the relationship between___________.
Threshold, resistance, and impedance
Current, resistance, and impedance
Current, voltage, and impedance
Threshold, voltage, and resistance
Current, voltage, and impedance
Pacing thresholds are NOT influenced by_________.
Lead maturation
Use of a steroid tip lead
Insulation break
Insulation material
Insulation material
Which of the following may occur during the maturation period of a device lead?
Tissue growth formulation of a fibrous capsule around the lead
Acute threshold increase
Inflammation
All answers are correct
All answers are correct
