Trouble Shooting

Question 1

What could cause loss of capture or an increase in pacing thresholds?

Answer 1

• lead fracture/failure
• perforation/dislodgment
• battery depletion
• loose set screw
• fibrosis
• drug interactions
• e-lyte imbalances
• ischemia or MI

Question 2

What are possible causes of inappropriate shock delivery?

Answer 2

• conducted AF
• sinus tach
• SVT
• T-wave oversensing
• myopotentials
• lead fracture
• FF atrial sensing in ventricular lead (crosstalk)
• noise
• connector issue

Question 3

What are possible causes of under/oversensing?

Answer 3

• lead fracture/insulation breach
• perforation
• drug interactions
• e-lyte imbalances
• ischemia or MI
• connector issue
• FF sensing (crosstalk)
• sub-optimal programming

Question 4

What are possible causes for an abnormal decrease in lead impedance?

Answer 4

• lead insulation breach
• perforation/dislodgment
• connector issue

Question 5

What are possible causes for an abnormal increase in lead impedance?

Answer 5

• lead fracture
• perforation
• connector issue
• fibrosis
• progression of cardiac disease

Question 6

What could a high number on the Sensing Integrity Counter mean?

Answer 6

• oversensing
• lead fracture
• loose setscrew

Question 7

What are 3 ways to attempt to reproduce a cardiac device problem?

Answer 7

• pocket manipulation
• have patient perform isometric exercises
• have patient change body positions

Question 8

Which of true below would you expect to see on the rate histogram if the patient is in AF the majority of the time?

1) V. Rate > V. Rate during AF
2) V. Rate < V. Rate during AF
3) V. Rate = V. Rate during AF

Answer 8

3 - will see the V. Rate = V. Rate during AF