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Flashcards in Implant Deck (40):
1

INR should be below what number

<1.5

2

Restart of heparin within 24hrs post implant represents what percentage risk of haematoma vs unanticoagulated patients

20% risk = 5x the risk of normal

3

Patients with existing CRM device have what % prevalence of lateral subclavian vein occlusion

25%

4

leads CAN be placed through mechanical valves - TRUE/FALSE

FALSE - can go through bioprosthetic, however long term effects unknown

5

3 Main veins for access

Cephalic
Subclavian
Axillary

6

Pros and Cons of Cephalic

Direct vision // Few complications

Small // Clean dissection

7

Pros and Cons of Axillary

Few complications // Large

Requires Fluro // Technically difficult

8

Pros and Cons of Subclavian

Easy access // Large

Requires Fluro // Pneu and Haemothorax // Crush

9

Why is it important to prolapse and not push the RV lead down

To ensure its not in CS // Risk of perforation

10

Where in the RA are leads normally placed

Appendage

11

What site in the RA may be more prone to phrenic stim

Free wall positions

12

3 types of LV pacing

Transvenous - CS
Epicardial
Endocardial - best haemodynamics, however chronic antiocoag reqiured

13

Where does the CS drain

Posteroseptum of RA

14

Name the CS veins in order from Prox-Dist

Middle cardiac vein
Posterior
Posterolateral
Lateral
Anterolateral
Anteroventricular

15

60% of leads in MCV can be advanced to where

Posterolateral free wall

16

Which two views are used to visualise the CS

RAO // LAO

17

Order the target veins for CRT

Lateral
Posterolateral
Posterior
Middle cardiac vein
Great cardiac vein

18

Improved clinical outcomes with LV lead position where vs where

Basal or mid wall better than apex

NEVER SEPTAL

19

Greater RV-LV lead tip separation preferred TRUE/FALSE

TRUE

20

Is lead I positive or negative in RV pacing

Positive

21

Is lead I positive or negative in LV pacing

Negative

22

Is lead III positive or negative in LV pacing

Positive

23

Is lead IIII positive or negative in RV pacing

Negative

24

BiV pacing produces what axis

Right Superior

25

Loss of a Q wave in I represents what

Loss of BiV pacing

26

Testing unipolar leads - which leads are attached where

Anode = Red = Tissue

Cathode = Black = Tip

27

PNS is a likely indicator of what

RV perforation

28

Tissue fibrosis improves stability however negatively effects other characteristics - why?

Increased effective distal electrode size = current drain

29

Can you get injury current from passive leads

YES - its just pressure on the myocardium

30

Active fixation time dependant changes at implant

Helix deployed = increased threshold for some minutes

Not seen in passive fixation

31

Non steroid leads have what threshold characteristics

Higher thresholds for first 24hrs rising over 7 days

Threshold stabilises 6wks post implant

Final threshold normally higher than at implant but lower than peak

32

Steroid leads have what threshold characteristics

Rarely exhibit marked changes in threshold over time

33

How many patients experience problems with pacemakers

1 in 8

34

What is the implant success rate for MICRA

99.2%

35

What are the MICRA tines made of and how is adherence defined

Nitinol

When 2 of 4 tines are attached

36

Satisfactory R-wave // Threshold // Impedance of Micra systems

R-wave > 5mV

Threshold <1.0V @ 0.24

Impedance 400-1500ohms

37

RVOT pacing leads are the same level as appendage on radiograph TRUE/FALSE

TRUE

38

Is there a difference in defib lead site placement?

No - same thresholds and sensing

39

Complete vs clinical success with regard to lead removal

Complete = All lead material removed

Clinical = Some lead material left behind but not negatively impacting goals

40

Success rate of lead extraction is ?%

90%