ICDs, Ablations, IR Anesthesia Flashcards
(30 cards)
Biventricular PPM
-Has 3 leads placed. RA + RV + LV
-LV placed via coronary sinus that can be tricky and takes time to access during surgery
Reed Switch
Synchronous to asynchronous w/ magnet placement
-2 metal strips that connect w/ magnet
-Inactivates sensing circuit
Bipolar PPM & ECG
Smaller pacer spiked on ECG d/t less EMI interference d/t less distance needed to travel
ERI
Electronic Replacement Indicator = Generator change
Why PPM often placed LEFT side
Most people are right-handed to place on left side bc less likely to have lead displacement
**Caution Left side placement d/t thoracic duct being on Left side
-Arms are tucked during PPM
Single chamber pacemaker
One lead that can be atrial or ventricular
-May see switching of pacer spikes on ECG
*May need to increase rate or milliamps to override
Dual chamber DDD
DDD 60-120 thresholds
Asynchronous mode
Paced independent of heart’s intrinsic rate = override intrinsic rate
Threshold
Minimal electrical output needed to CONSISTENTLY contract or capture (atrial or ventricular or both)
*Turn down mA slowly until capture lost (around 0.7-1.0 mA). Then slowly turn up mA until capture.
**Then set mA 2x threshold
Failure to capture
PPM output does NOT cause myocardial depolarization
Failure to sense
Failure of PPM to recognize intrinsic cardiac electrical activity
What is the single most important risk factor for overall mortality & sudden cardiac death?
Reduced left ventricular ejection fraction
Brugada syndrome is an indication for …..
ICD
Brugada Syndrome
*RBBB w/ ST elevation in R precordial leads (V1-V3)
-Caused by mutation in voltage gated sodium channels. Males > females.
-3 types = coved + saddle back w/ ST elevation >/< 2mm
-Syncope, dizzy, palpitations
How many codes do a PPM & an ICD have
PPM = 5 codes
ICD = 4 codes
ICD joules for V-fib
10-30 joules. Starts higher than ventricular tachycardia shock
Why is it important to have ICD interrogated before & after surgery?
Prevents from not having enough juice to shock & get out of lethal rhythm if needed intraoperatively
What is needed with ICD if monopolar cautery used?
Grounding pad
If see shock coils on CXR
Safe to assume ICD
Stimulating parts of CIED placement requiring higher level of anesthesia
-Local injection
-Pocket formation
Cautery & CIEDs increase
airway fire risk of 3
-Common gas outlet (CGO) blend of 3/1 = fiO2 or ~30%
3 Important points of anesthesia for AICD
-Pts can be less healthy w/ decreased EF
***Watch circulation time & drug effects = etomidate, propidate, prop gtt all work well
-Transcutaneous pads on & functional incase internal device failure with DFT test
CIED
Cardiac implantable electronic device
CIED & monopolar cautery, important to have what ready as an anesthetist?
-Chronotropic meds & emergency pacing if pacer dependent
-Ephedrine, atropine, EPI, dopa
-Use short burst <5sec to ensure no device interference detection
