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Sales Training II > EP > Flashcards

EP Flashcards

1
Q

What are atria?

A

Two upper chambers of heart

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2
Q

What are ventricles?

A

Two lower chambers of heart

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3
Q

What is the plumbing of the heart?

A

Refers to veins that supply the heart with blood and the arteries that carry it away (problem - heart attack)

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4
Q

What is the electrical system of the heart?

A

Refers to wiring - conducts beats signal from atria to ventricles (problem - arrhythmia)

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5
Q

What is an arrhythmia?

A

Results from conduction defects of hearts electrical system - can cause impulses to happen too fast, too slowly, erratically

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6
Q

What is tachycardia?

A

A rapid heart rhythm, usually more than 100 BPM

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7
Q

What is bradycardia?

A

A slow heart rhythm, usually under 60 BPM

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8
Q

What is fibrillation?

A

A rapid or irregular muscular twitching

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9
Q

What is defibrillation?

A

The stopping of rapid or irregular muscular twitching by administering a controlled electric shock to restore normal rhythm- it is like hitting reset or restart button on heart’s electrical system

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10
Q

What is a pacemaker?

A

Artificial device planted in chest or abdomen which sends electrical impulses to restore the heart’s rhythm

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11
Q

What is the difference between a single chamber and dual chamber pacemaker?

A

Single chamber senses and paces only the lower chambers of the heart
Dual chamber senses and paces both the top (atria) and lower (ventricles) chambers

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12
Q

What are the three components of a pacemaker?

A

Pacemaker Device (Generator or “Can”) - provides power
Leads - insulted wires that carry electrical impulse to heart
Programmer - allows for hookup to computer to monitor and adjust

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13
Q

What is an ICD?

A

Implantable-Cardioverter Defibrillator - artificial device implanted in the chest or abdomen which continuously monitors the heart and delivers life-saving therapies to treat dangerously fast heart rhythms or fatal arrhythmia

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14
Q

What is the difference between single and dual chamber ICDs?

A

Single attached to right ventricle

Dual attached to right ventricle and right atrium

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15
Q

What is difference between Pacemaker and ICD?

A

In addition to pacing the heart, an ICD can also shock the heart when a dangerous arrhythmia is detected

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16
Q

What are the three components of an ICD?

A

ICD Device (Generator or “Can”)
Leads
Programmer

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17
Q

What does CRT stand for?

A

Cardiac Resynchronization Therapy

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18
Q

Where is a CRT implanted?

A

Implanted into chest or abdomen

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19
Q

What is a CRT device designed to treat?

A

Heart failure

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20
Q

What does a CRT system consist of?

A

Generator, Leads, Programmer

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21
Q

What is the different between CRT-P and CRT-D?

A

P is for pacing, D is for Defibrillation

22
Q

What is a lead?

A

An insulated wire that carries the electrical impulse from the pacemaker/ICD to the heart

23
Q

What are the characteristics of Polyurethane?

A

Thermoplastic, melts at 185-225 C, high abrasion resistance and shear strength, highly susceptible to thermal damage

24
Q

What are the characteristics of Silicone?

A

Thermoset, highly temperature resistant, high susceptible to mechanical damage

25
Q

What are the characteristics of Copolymers?

A

Combination of both materials, susceptible to thermal and mechanical damage

26
Q

What are the 5 Cardiac Rhythm Procedures?

A 
Primary Implantation
Generator Change Out
Upgrade to more complex multi-lead PM or ICD
Addition of lead to an existing system
Revision of Pocket
27
Q

Why do generators need to be changed out?

A

Battery depletion

28
Q

Why upgrade to a more complex pacemaker?

A

New indications, dual chamber, ICD, CRT

29
Q

Why add a new lead?

A

New indication, lead malfunction

30
Q

Why revise a pocket?

A

Pocket hematoma, infection, erosion, migration, Twiddler’s syndrome

31
Q

What are the procedural steps in primary implantation?

A

Make small incision 1-2 inches long in upper chest, PM/ICD/CRT is implanted under local anesthesia, guide leads to vein in heart, connect back end of leads to pulse generator which is placed under skin over the pectoral muscle

32
Q

How long does a primary implantation take?

A

1-2 hours

33
Q

How long does a pacemaker battery typically last?

A

5-7 years

34
Q

What are the steps to generator replacement/upgrade?

A

Make small incision, remove entire generator from leads, replace generator, (cleaning out pocket is optional, some leave existing capsule), connect existing leads to new device, implant new device, close

35
Q

Are changeout procedures longer or shorter than primary?

A

Typically shorter

36
Q

What are reasons for lead extraction?

A

Infection, buildup of scar tissue at end of lead which comes into contact with inside of heart (results in exit block which is when lead may need more energy to be effective than PM/ICD can provide), interference between lead and blood flow, interference between lead and other leads

37
Q

What are options when a lead is damaged and it is known interoperatively?

A

Replace lead (risk, time) or leave as good enough (comprises future therapy or issues with programmability, can result in revision/hospitalization)

38
Q

What happens if lead is damaged and it is not realized during procedure?

A

Potential complications, compromises future therapy and programmability, could result in revision/hospitalization

39
Q

What are target procedures for PB in Cardiac?

A

PM and ICD generator replacements and upgrades

40
Q

Why is PB so popular in changeouts?

A

Greater number of leads and longer duration of implant increases value prop as fibrous encapsulation gets worse

41
Q

Why not target primary procedures?

A

High volume of cases can result in cost pushback from hospital

42
Q

What is PB value proposition in gen replacements?

A 
Improved safety (lower temperature reduces thermal risk to transvenous leads)
Increased operating efficiency (dissects well through fibrotic tissue, no need for other instruments)
Equivalent healing to scalpel (delayed wound healing with standard of care)
43
Q

What are recommended settings for PB in EP?

A

Incision (Cut 5), Subcutaneous (Cut 5-7), Coag (5-8), Cut 6, Coag 6 is most typical on subcutaneous. Cut 6 reduces chance of sparking on can.

44
Q

What mode should be used around leads?

A

Cut!

45
Q

What are electrosurgical best practices?

A

Use short bursts of energy, approach leads in parallel orientation whenever possible, use lowest power settings which are effective

46
Q

What mode should be used during capsulectomy?

A

Coag for better bleeding control

47
Q

What are best practices for skin cutting?

A

Less mechanical resistance than scalpel - let device do work

48
Q

What are best practices for coagulation?

A

Use electrode edge and not insulated side of tip, use a light feathering technique, deliberate precise motions result in greater thermal effect

49
Q

How should the device be positioned around leads?

A

Parallel

50
Q

How should PB be cleaned?

A

Using slot cleaner on device holster and not a scratch pad - scratch pad compromises performance

Sales Training II (8 decks)

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