Device Therapy Concepts Flashcards by Jessica Hayward

What is the mode most likely being used in the ECG below:

a. AAI
b. VOO
c. DDD
d. VVI

d. VVI

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What is the underlying rhythm in the ECG?

a. Atrial flutter
b. Complete heart block
c. NSR
d. Atrial fibrillation

b. Complete heart block

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What is the correct interpretation?

a. Normal sinus with atrial pacing
b. Normal sinus with ventricular pacing with failure to capture
c. Normal sinus with atrial pacing with failure to capture
d. Normal sinus with ventricular pacing

b. Normal sinus with ventricular pacing with failure to capture

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What is the correct interpretation?

a. Atrial sensed-ventricular sensed
b. Atrial sensed-ventricular paced
c. Atrial paced-ventricular paced
d. Atrial paced-ventricular sensed

c. Atrial paced-ventricular paced

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What is the most likely explanation for the narrower paced complexes in the following ECG?

a. CRT device
b. Not being paced at all
c. Only atrial pacing occurring
d. ICD device

a. CRT device

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TRUE OR FALSE

CRT devices are programmed to pace as close to 100% as possible.

TRUE

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What is the correct interpretation?

a. Atrial paced-ventricular sensed
b. Atrial sensed-ventricular paced
c. Atrial paced-ventricular paced
d. Atrial sensed-ventricular sensed

c. Atrial paced-ventricular paced

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What is the correct interpretation?

a. Atrial fibrillation with AS-VP with AP and PACs
b. Normal sinus with AS-VP and failure to capture
c. Normal sinus with AS-VP with occasional AP and PACs
d. Atrial fibrillation with AS-VP with AP and PACs

c. Normal sinus with AS-VP with occasional AP and PACs

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What is the correct interpretation?

a. Normal sinus rhythm with ventricular paced beats and pseudofusion beats
b. Normal sinus rhythm with ventricular paced beats
c. Atrial fibrillation with ventricular paced beats and pseudofusion beats
d. Atrial fibrillation with ventricular paced beats

c. Atrial fibrillation with ventricular paced beats and pseudofusion beats

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What is the correct interpretation?

a. Atrial pacing with a run of PMT
b. Dual chamber pacing
c. Ventricular pacing
d. Dual chamber pacing with a run of PMT

d. Dual chamber pacing with a run of PMT

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If the indication is 24 hours post-implant for the above ECG, what is the most likely reason for no tracing in V6?

a. Lead wire fell off
b. Technologist error
c. No access to the correct position
d. Damaged lead wire

c. No access to the correct position

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TRUE OR FALSE

PMT is a re-entry tachycardia.

True

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What is the correct interpretation?

a. Atrial fibrillation with ventricular pacing
b. Normal sinus with atrial pacing
c. Atrial fibrillation with atrial pacing
d. Normal sinus with ventricular pacing

b. Normal sinus with atrial pacing

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What is the correct interpretation?

a. Normal sinus with ventricular pacing
b. Normal sinus with atrial pacing
c. Normal sinus with atrial pacing and PACs
d. Normal sinus with ventricular pacing with PACs

c. Normal sinus with atrial pacing and PACs

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What is the underlying rhythm of the following ECG?

a. Atrial flutter
b. Normal sinus rhythm with left bundle branch block
c. Atrial fibrillation
d. Normal sinus rhythm

c. Atrial fibrillation

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TRUE OR FALSE

Infection will usually present itself within a week of implant.

False

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TRUE OR FALSE

ICM are implanted for arrhythmias that have not been able to be documented through other cardiac monitors.

True

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What is the most appropriate mode for a patient with complete heart block?

a. AAI
b. VVI
c. DDD
d. VVIR

c. DDD

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What is most appropriate mode for a patient with atrial fibrillation and chronotropic incompetence?

a. VVI
b. DDD
c. VVIR
d. AAI

c. VVIR

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Failure to capture refers to which of the following?

a. The device does not sense the appropriate cardiac impulses

b. The device senses non-cardiac impulses

c. A device doesn’t know when to turn off

d. The generator is unable to deliver sufficient energy to cause depolarization

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Temporary pacers may be used in the following situations, except:

a. Lyme disease
b. Drug overdose
c. Ventricular fibrillation
d. Complete heart block

c. Ventricular fibrillation

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Threshold testing is done to make sure there is an adequate safety margin to ensure capture. Another reason is:

a. to check impedance

b. So the patient will feel like they came to the clinic for a reason

c. So that the sensitivity can be adjusted

d. To keep the energy output as low as possible to conserve battery

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d. To keep the energy output as low as possible to conserve battery

TRUE OR FALSE

The downside of VDD pacing is that it only senses the ventricle.

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False

MATCH

The maximum rate that the device will track

a) PVARP
b) UTR
c) ATP
d) PMT
e) Pacing Threshold
f) USR
g) AMS
h) Pulse width

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b) UTR

MATCH Tachycardia started by a retrograde P that causes an endless loop a) PVARP b) UTR c) ATP d) PMT e) Pacing Threshold f) USR g) AMS h) Pulse width

d) PMT

MATCH The device counts more As than Vs, switches to not track the atria a) PVARP b) UTR c) ATP d) PMT e) Pacing Threshold f) USR g) AMS h) Pulse width

g) AMS

MATCH Pacing that is given to terminate an arrhythmia a) PVARP b) UTR c) ATP d) PMT e) Pacing Threshold f) USR g) AMS h) Pulse width

c) ATP

MATCH Maximum rate the device will pace when being sensor driven a) PVARP b) UTR c) ATP d) PMT e) Pacing Threshold f) USR g) AMS h) Pulse width

f) USR

MATCH The time that the pacing stimulus is given over a) PVARP b) UTR c) ATP d) PMT e) Pacing Threshold f) USR g) AMS h) Pulse width

h) Pulse width

MATCH The amount of energy required to make the heart depolarize consistently a) PVARP b) UTR c) ATP d) PMT e) Pacing Threshold f) USR g) AMS h) Pulse width

e) Pacing Threshold

MATCH The period after the ventricle depolarizes that the atrium is in refractory a) PVARP b) UTR c) ATP d) PMT e) Pacing Threshold f) USR g) AMS h) Pulse width

a) PVARP

Why is it important to sense intrinsic beats when they happen? a. To reduce pacing b. To conserve battery energy c. To prevent R on T events d. All of the above

d. All of the above

The risks of using a magnet on a pacemaker include: a. No risks in using a magnet b. Can cause NSR, PVCs, PACs c. Pacemaker syndrome, PMT, R on T d. Can cause patient intrinsic beats to increase

c. Pacemaker syndrome, PMT, R on T

The patient has had multiple episodes of VT treated with ATP (antitachycardia pacing) in a 24hrs period (VT storm). This transmits via remote monitoring, so the clinic calls the patient and asks them to come in to be assessed. The patient is confused as they have not felt any shocks. Why didn’t the patient notice the ATP? a. ATP is just the monitoring process b. ATP is an atrial arrhythmia c. ATP is silent d. ATP is just pacing faster than the rhythm enough to break it

d. ATP is just pacing faster than the rhythm enough to break it

What is pacemaker syndrome?

A lack of synchrony between the atria and ventricles. (similar to 3rd degree AVB) People feel dizzy, SOBOE, Fatigued, Palpitations, Heart failure, Neck fullness/pulsation

What is the difference between VVI and VVIR?

VVI - FIXED rate VVIR - increased w/ exercise - RATE RESPONSIVE

What is PMT?

Pacemaker Mediated Tachycardia - - Pacemaker makes the V-Tach - Reading T-wave as P-wave

What is CRT? (Cardiac Resynchronization Therapy)

Bi-Ventricular pacing - (there is a gap between pacer & QRS) Used to resynchronize the ventricles during repolarization More narrow QRS complexes Right and Left ventricles need to work together with the atria - ALL pacing together, Very short PRI

Indications for Pacemakers/ICD's

- AV Blocks (1st, 2nd & 3rd) - Persistent A-Fib - Sick Sinus Syndrome (Tachy/Brady) - Sinus Arrest - Sinus Node not firing - Sinus Node disease - Syncope/Symptomatic Bradycardia - Congenital defects - not uncommon for babies - LONG QT syndrome - prevent short long R-R's - Valve surgeries

What does remote monitoring do?

Sends info to the clinic so the patient doesn't have to come in as often.

What is the difference between VOO and VVI pacing?

VOO - Does not sense, just paces Ventricles, FIXED RATE mode VVI - Senses and Paces Ventricles, also INHIBITS, constantly monitoring & taking action when NECESSARY

What does ICD stand for?

Implantable Cardiac Defibrillator - allow the arrhythmia time to terminate WITHOUT shocking - ATP may be first treatment

PMT stands for...

Pacemaker Mediated Tachycardia

ICM stands for...

Implantable Cardiac Monitor ex. Implantable Loop recorder to monitor b/c Holter didn't show anything Used to monitor & record arrhythmias & patient-activated events

AMS stand for...

Automatic Mode Switching

USR stands for...

Upper Sensor Rate - based on how active a person is. Fastest HR for pt.

ATP stands for....

Anti-Tachycardia Pacing

UTR stand for...

Upper Tracking Rate - How fast atrial tracks ventricles

PVARP stand for...

Post-Ventricular Atrial Recovery Period

If Lead Impedence is HIGH, what is the issue with the lead?

HIGH on CRACK = CRACK in the LEAD ↑ 200 omhs

If Lead Impedence is LOW, what is the issue with the lead?

SILICONE issue - lead is open and energy is leaking ↓ 200 omhs

Name some pacemaker malfunctions.

- Undersensing - does not detect intrinsic beats - Oversensing - device "sees" something that isn't there, inhibiting pacing - Failure to capture - Sends out an impulse without enough energy to depolarize - Device reset - - Impedance changes - changes greater than or less than 200 ohms.

When is a Temporary Pacemakers used?

- Inferior MI - Complete ♥ Block - Surgery w/ Severe Bradycardia - Overdose of Beta Blockers - Lyme Disease - Bridge while waiting for permanent PMI (permanent pacemaker implantation)

Device Therapy Concepts Flashcards

(53 cards)