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IBHRE Devices Comprehensive Guide –
Mode of pacing that best reduces risk of AF starting in patients with sinus node dysfunction - Correctanswer-AAI Pacemaker
Which implantable device used long term increases patient's risk of developing AF - Correct answer-VVI What kind of device/lead may cause pocket stimulation - Correct answer-Unipolar Cause of lead impedance lowering - Correct answer-Insulation problem SVC Syndrome - Correct answer-endothelial damage caused by repeated trauma from lead; dyspnea,facial swelling, head fullness, cough, arm swelling
Secondary prevention - Correct answer-when a patient receives an ICD because they were previouslyresuscitated from cardiac arrest
Basis for patient receiving PPM for brady - Correct answer-patient symptoms and ambulatorymonitoring ECG
When do you give a pacemaker for 1st degree block - Correct answer-HV >100ms Most common cause of brady - Correct answer-SA Node disease EOL - Correct answer-end of life: pacemaker dies
ERI - Correct answer-elective replacement inficator; consider replacement, low battery BOL - Correct answer-beginning of life POR - Correct answer-Power on reset; near death with loss of volatile memory, default backup pacingstarts
Reason to implant PPM on symptomatic patient with supraventricular brady - Correct answer-Sick sinussyndrome
Pacemaker syndrome - Correct answer-caused by non physiologic VVI pacing Where does drug elimination take place ?Urinary excretion or liver, lungs or other organs Drug concentration is affected by?Absorption, distribution, and elimination What type of drugs restore or enhance cellular activity by mimicking natural body chemicals that bind tocell receptions? AgonistsWhat type of drugs inhibit or block action by occupying a cell receptor? AntagonistsWhat are the major types of cardiac drugs? Nitrates, Inotropes, sympathominetics, sympatholytics, antiarrhtthmicsWhat type of drug dilates veins and arteries and are used to manage chest pain? NitratesWhat types of drugs like digitalis increase intercellular calcium and increase myocardial contractility? InotropesWhat drugs like isoproterenol mimic sympathetic activity? Sympathominetics
Class of antiarrhythmics that can raiese patient's stimulation threshold and cause loss of capture -Correct answer-class 1c
In DDDR pacemakers the max tracking rate is the fastest rate the ventricle can be paced in response to -Correct answer-sensed atrial events
What does ablate and pace mean in relation to AF - Correct answer-ablate AV node, place DDDRpacemaker
When is stimulation threshold lowest? - Correct answer-Time of implant What best reduces acutre rise in thresholds within first two months after initial implant? - Correctanswer-IV Steroids
WHen is the stimulation threshold the highest? - Correct answer-1 month in (Acute rejection phase) Slew Rate - Correct answer-Measure of the voltage over time of the peak slope of intercardiac signal What sensitivity measurement with PSA post implant of gen change - Correct answer-R Wave peak topeak and slew rate
Main reasons ICD Patients get inappropriate shocks - Correct answer-Lead oversensing andunrecognized SVT
Ideal V Capture threshold - Correct answer-<1V (preferably less than 0.5V) Ideal A Capture threshold - Correct answer-<1.5 V Ideal V Wave Sensing - Correct answer->4 mV Ideal A Wave Sensing - Correct answer->1.5 mV
Primary Prevention - Correct answer-when patient receives ICD without history of cardiac arrest orsustained VT
Secondary Prevention - Correct answer-prevention of sudden cardiac death in patients who havesurvived prior cardiac arrest or sustained VT
MADIT II - Correct answer-Clinical trial that showed that EP Study was not necessary for ICD therapy tobe effective in patients with low EF and prior MI
Class I Reccomendation - Correct answer-ICD isindicated for patients with non sustained VT due to priorMI, LVEF less than 40% and inducible VF or sustained VT at EP study
Twiddler's syndrome - Correct answer-when a patient manipulates and rotates the pulse generator inpocket so many turns that it results in lead dislodgement, diaphragmatic stimulation or loss of capture
ICD shock energy range - Correct answer-0.1 to 40 Joules Most efficient shock waveform - Correct answer-biphasic Setting for DFT after testing - Correct answer-10 Joules higher than DFT Symptom that is best suited to add array - Correct answer-Enlarged LV Advantages of SICD - Correct answer-no fluoro needed at implant, easy to explant, no risk of vascularinjury
Where is SICD lead-electrode placed? - Correct answer-Left parasternal border from xiphoid to angle ofLouis
ICD output for VF without DFT - Correct answer-10 joules below maximum output
Most common reason for lead removal - Correct answer-device infection most common organism causing implanted device infection - Correct answer-staphylococcus When is complete removal of both leads not recommended - Correct answer-non functional leads invery old patients
When can medications be used instead of extraction - Correct answer-incision infection only, if thebacteremia is not due to device or leds
Power sheaths used in extraction - Correct answer-RF, Laser, Mechanical
