Pacemakers and Defibrillators Flashcards by Anna Logan

Define CRMD

Cardiac Rhythm Management Device

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Where are pacing leads placed within the heart?

Right atrium and right ventricle

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What are indications for a pacemaker? (5)

Sinus node disease–failure to form impulse
AV node disease–failure to conduct impulse
Long QT syndrome
Hypertrophic obstructive cardiomyopathy
Dilated cardiomyopathy

Note: Most pts fall into first 2 indications listed.

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What conditions require 100% ventricular pacing?

hypertrophic obstructive cardiomyopathy

dilated cardiomyopathy

Note: Short AV delays (120-150msec) are programmed.

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What are 3 pacemaker classification systems?

NASPE - North American Society of Pacing and Electrophysiology

BPEG - British Pacing and Electrophysiology Group

NBG - Naspe and Bpeg Generic

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NBG classification of Bradycardia Support Pacemakers

What does each number represent?

Position 1: Pacing chamber

2: Chamber sensed
3: Responses to sensing (directly tied to position 2, if no value for 2, no value for 3 is possible)
4: Programmable functions
5: Anti-tachycardia functions

Note: Directly from NBG Code website because notes don’t make sense o/w.

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What are modes of response to sensing?

I (inhibited) – withhold a pacemaker output in response to a sensed event.

D (dual) choices: inhibit PM, track the sensed event, inhibit output on sensed channel and trigger output to maintain synchrony

T (triggered) – produces output spikes coincident with the sensed signal (diagnostic only)

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What are programmability functions?

R (rate responsive) – device is capable of a rate responsive function

C (communicating) – capable of transmitting or receiving data for informational or programming purposes.

M (multi-programmable) – device can be programmed in more than 3 parameters: Rate, sensing, output, refractory periods, mode, hysteresis (means history vs. current condition essentially)

P (simple programmable) – limited to 3 or fewer programmable parameters

O (none) – not programmable

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What are anti-tachycardia functions?

P (paced) – pace the patient out of tachycardia
S (shocks) – deliver a defibrillating shock
D (dual – paced and shocks)
O (none)

Note: This is position 5.

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For anti-tachycardia functions, most bradycardia devices are ___ and most ICDs are ____.

O, none

D, dual

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What are asynchronous modes?

AOO – Fixed rate atrial pacing

VOO – Fixed rate ventricular pacing

DOO – Fixed rate AV sequential pacing, paces both atria and ventricles

Note: When a magnet is placed on the PM, asynchronous mode initiates and goes into a fixed pacing mode despite heart activity.

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What is DDD mode?

Paces Atrium and Ventricles
Senses Atrium and Ventricular signals

Sensed atrial signal will cause the device to inhibit the atrial output, a timer starts that will cause a triggered ventricular output after a certain interval but, if the patient has an R wave during the triggering interval the ventricular output will be inhibited.

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In the event of high atrial rates and heart block, DDI will most resemble what pacemaker setting?

VVI

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What is AAI mode?

atrial-inhibited pacing

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What is VVI mode?

ventricular inhibited pacing

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What is VAT mode?

Atrial-triggered, ventricular pacing

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What is VDD mode?

It is atrial triggered, ventricular inhibited pacing

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What is DVI mode?

Dual-sequential pacing, ventricular inhibited.

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What is DDI mode?

Dual-chamber, sequential inhibited pacing

Note: Does not trigger where a signal is sensed.

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The implantable PM is placed in the pectoral region. The lead enters the ___________ immediately superior to the ______________________.

right external jugular vein

medial end of the clavicle

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Transvenous pacing leads may be:

unipolar

bipolar

Note: Leads are placed endocardially.

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What is depicted here?

Epicardial and unipolar PM

Lead A is a space if B should fail.

Lead B is connected to the generator.

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What is AOO mode?

asynchronous pacing of atria–regardless of atrial activity

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What PM mode would generate this ECG?

AAI

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What PM mode would generate this ECG?

What PM mode?

What PM mode resembles unifocal PVCs?

VOO

What is depicted?

atrial pacing

What is depicted?

AV sequential pacing

What is depicted?

failure to capture

What are the types of endocardial leads(transvenous)?

active fixation --metal screw-in passive fixation --rubber fins or tines

What are the types of epicardial leads?

screw-in sew-on

What are the different polarities of pacing leads?

unipolar --highest reliability bipolar --improved rejection for better sensing multipolar --special purpose leads

What are the different lead tips?

steroid eluting --believed that scarring is decreased non-steroid eluting carbon--least scarring but tend to take more current

What is depicted?

PA catheter with bipolar ventricular pacing wire

What is depicted? Label

Pacing Swan-Ganz

What is depicted? Where is the pacing probe located?

Chandler V-pacing probe 19 cm from distal end

What rate modulation sensors are currently approved in the US?

Vibration sensor Motion sensor Minute ventilation (bioimpedance sensor) RV pressure

What sensors are very sensitive to stray electromagnetic interference where pts have been inappropriately treated for pm driven tachycardias?

Minute ventilation sensors

What setting is recommended for the perioperative period for PMs?

Rate modulation set to "OFF" to prevent confusion of intrinsic tachycardia with PM induced tachycardia.

Which rate modulation sensors have little perioperative issues?

RV pressure sensors

What are activity sensors that adjust heart rate to activity?

Motion sensor Minute ventilation sensor

What is an example of pacemaker magnet behavior?

_Asynchronous "high-rate" pacing_

What should you do if performing upper body surgery with PM pt? What should you do if performing lower body surgery with PM pt?

Set PM to asynchronous activity if not emergent. If lower body surgery, PM should be OK as is.

Which type of cautery is better used with a PM patient?

Bipolar is safer (current passes between forceps) than monopolar since this current has to pass through the patient.

What situations require PM reprogramming?

Any rate responsive device Special pacing indication (eg. hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, pediatric patients) Major surgery in chest or abdomen Special procedures like: * immersion lithotripsy * transurethral resection * hysteroscopy * electroconvulsive therapy * MRI * Sux use

What does the horizontal line after shock delivery show?

The cardiograph was blocked or disconnected for its protection during the period of shock.

Identify the defibrillation positions.

A. Correct positioning in a patient with a permanent PM. Also considered the best position for paddles. Less current needed. B. Placement recommended by the American Heart Association. Note: Place below sternal notch.

What is synchronized defibrillation also known as?

cardioversion

When should a synchonized defibrillation take place? What point is considered the vulnerable period?

M designates when a shock should be applied in the cardiac cycle. VP is the vulnerable period and shock delivery may result in ventricular fibrillation.