ReTest Desk 1 Flashcards by Alyssa Balac

The following is true about atrial fibrillation except

Atrial fibrillation is the most common arrhythmia seen in clinical practice

Atrial fibrillation causes 20% of all strokes

Conservative estimates predict 5 million people will have afib by 2050

The mortality rate for a patient with afib is nearly 75%

How well did you know this?

Not at all

Perfectly

Atrial fibrillation is noted for

Regular QRS intervals
Chaotic atrial activity
Discernable P-waves
Heightened exercise tolerance

Chaotic atrial activity

How well did you know this?

Not at all

Perfectly

Symptoms of Afib include all of the following except

Weakness and fatigue
Regular pulse rate
Palpitations and chest pain
Shortness of breath and confusion

Regular pulse rate

How well did you know this?

Not at all

Perfectly

All of the following are suspected causes of atrial fibrillation except

Stroke
Sleep apnea
Exposure to stimulants like caffeine, tobacco or alcohol
High blood pressure

Stroke

How well did you know this?

Not at all

Perfectly

This structure is a suspect in clot formation in patients with atrial fibrillation.

Left atrium
Right atrium
Left atrial appendage
The coronary sinus

Left atrial appendage

How well did you know this?

Not at all

Perfectly

These structures are suspected in starting atrial fibrillation.

The lungs
The SVC and aorta
The pulmonary veins
The pulmonary arteries

The pulmonary veins

How well did you know this?

Not at all

Perfectly

Progression of Atrial fibrillation is defined as

Permanent - Persistent - Paroxysmal
Paroxysmal - Permanent - Persistent
Paroxysmal - Persistent - Permanent
Persistent - Paroxysmal - Permanent

Paroxysmal - Persistent - Permanent

How well did you know this?

Not at all

Perfectly

The following are known complications of Afib ablation except

Atrial esophageal fistula and phrenic nerve damage
Cardiac tamponade from cardiac perforation
Deep venous thrombosis in the lower leg
Stroke and fluid overload

Deep venous thrombosis in the lower leg

How well did you know this?

Not at all

Perfectly

“Entrance” and “Exit” block of the pulmonary veins refers to:

Atrial fibrillation exiting the heart

Pulmonary vein potentials not able to exit and enter the pulmonary vein

The pulmonary veins are not associated with atrial fibrillation in the patient

The atrial fibrillation is located entirely in the left atrium

Pulmonary vein potentials not able to exit and enter the pulmonary vein

How well did you know this?

Not at all

Perfectly

Which of the following catheters are commonly utilized for an AF ablation?

HRA, RVOT, Ablation, Halo, Lasso
Ultrasound, RVOT, His
ICE, Lasso, Ablation, Coronary Sinus
Coronary Sinus, Ablation, Halo, His

ICE, Lasso, Ablation, Coronary Sinus

How well did you know this?

Not at all

Perfectly

What catheter is commonly inserted when performing a pericardiocentesis?

JR 4
JL 3
JL 4
Pig tail

Pig tail

How well did you know this?

Not at all

Perfectly

The initiation of A-Fib most commonly originates from

Left atrial appendage
Inferior vena cava
Posterior atrial wall
Pulmonary veins

Pulmonary veins

How well did you know this?

Not at all

Perfectly

Patients with atrial flutter

Have a higher risk of developing atrial fibrillation
Have a “saw tooth” appearance pattern on the 12 lead ECG
Have a higher risk of stroke
All are correct

All are correct

How well did you know this?

Not at all

Perfectly

Symptoms can include all of the following except

Dizziness
Palpitations
Frequency and urge to urinate
Shortness of breath

Frequency and urge to urinate

How well did you know this?

Not at all

Perfectly

Typical flutter uses all the following structures in its circuit except

Tricuspid annulus
Mitral annulus
Lateral right atrial wall
Atrial septum

Mitral annulus

How well did you know this?

Not at all

Perfectly

The perpetuation of typical atrial flutter requires:

An area of slow conduction
The SVC
The distal coronary sinus
The left atrial appendage

An area of slow conduction

How well did you know this?

Not at all

Perfectly

Typical counter clockwise flutter accounts for what percentage of all flutter cases?

50%
30%
75%
90%

90%

How well did you know this?

Not at all

Perfectly

Clock-wise flutter is characterized by all of the following except

The flutter wave front traveling down the atrial septum
Positive P-waves in the inferior leads
The wave front traveling up the lateral anterior right atrial wall
Negative P-waves in the inferior leads

Negative P-waves in the inferior leads

How well did you know this?

Not at all

Perfectly

Atypical atrial flutter may be the result of

Scarred atrial tissue
Previous surgical intervention
Previous ablative therapies
All are correct

All are correct

How well did you know this?

Not at all

Perfectly

All of the following are elements of ‘entrainment’ except

Is a maneuver to assist in locating the structures in the flutter circuit
Requires pacing the atrial tissue at a faster rate than the flutter rate
Is a maneuver to help move the wave front to a different location
Requires the flutter to advance to the pacing cycle length while pacing

Is a maneuver to help move the wave front to a different location

How well did you know this?

Not at all

Perfectly

Cardioversion of atrial flutter includes all of the following except

Need for the sync button to be activated before the shock is delivered
Can usually be accomplished with 50-100 joules
Can usually be accomplished with 10-20 joules
Should be performed in the presence of the Electrophysiologist

Can usually be accomplished with 10-20 joules

How well did you know this?

Not at all

Perfectly

All of the following describe atrial tachycardia except

An atrial focus other than the SA node
An ectopic atrial pacemaker coming from structures near the atria
An atrial focus coming from the pulmonary veins with an atrial rate greater than 300 beats per minute
An atrial focus coming from the pulmonary veins causing a tachycardia rate of 150 beats per minute

An atrial focus coming from the pulmonary veins with an atrial rate greater than 300 beats per minute

How well did you know this?

Not at all

Perfectly

All of the following are symptoms of atrial tachycardia except

Dizziness
Chest pain
Palpitations
Slow heart rate

Slow heart rate

How well did you know this?

Not at all

Perfectly

All of the following are common locations for atrial tachycardia except

The anterior left ventricle
The crista terminalis
The pulmonary veins
The coronary sinus ostium

The anterior left ventricle

How well did you know this?

Not at all

Perfectly

The following are classified as atrial tachycardias except Focal Atrial tachycardias Multifocal atrial tachycardias Intra-atrial re-entry tachycardia Atrial flutter

Atrial flutter

Atrial tachycardia P wave morphology will most likely resemble the sinus P wave for which focus Left inferior pulmonary vein Coronary sinus ostium Superior vena cava Tricuspid annulus

Superior vena cava

Inappropriate sinus tachycardia can have the following characteristics except Comes from dysautonomia or the sinus node itself Can frequently occur in young women Can be brought on by emotional distress Is easily manageable with medications

Is easily manageable with medications

Ventricular entrainment during atrial tachycardia with tachycardia continuing after pacing reveals V-A-V response A-V-A response V-A-A-V response A-V-V-A response

V-A-A-V response

The coronary sinus catheter is important for determining activation sequence in atrial tachycardia diagnosis True False

True

Multifocal atrial tachycardia refers to A tachycardia focus from more than one area of the atrium A tachycardia focus coming from the sinus node A tachycardia focus coming from the AV node A tachycardia focus coming from more than one area of the ventricle

A tachycardia focus from more than one area of the atrium

Bradycardia is defined as A slow heart rhythm with rates of 70-100 beats per minute A heart rate of 65 with blood pressures below 80/50 A slow heart rhythm with rates of 70 and blood pressure of 60/40 A slow heart rhythm with rates below 60 and dizziness

A slow heart rhythm with rates below 60 and dizziness

Symptoms of bradycardia can include all of the following except Syncope, dizziness Fatigue, shortness of breath Feeling of alertness and exertional tolerance Confusion and diminished mental acuity

Feeling of alertness and exertional tolerance

The following can cause bradycardia except Sick Sinus Syndrome An accessory pathway Chronotropic Incompetence Sinus arrest

An accessory pathway

First degree AV block is defined by A PR interval of 200 ms or greater More P waves then QRS complexes A need for a permanent pacemaker Dissociated P waves

A PR interval of 200 ms or greater

Second degree heart block Wenckebach is characterized by Dissociated P waves Second degree heart block Wenckebach is characterized by Progressively lengthening PR interval followed by a dropped QRS P waves conducting to a QRS on every other beat

Progressively lengthening PR interval followed by a dropped QRS

Third degree heart block is characterized by Dissociated (no relationship) P waves to the QRS complex PR intervals greater than 300 ms Progressively lengthening PR interval followed by a dropped QRS P waves conducting to a QRS on every other beat

Dissociated (no relationship) P waves to the QRS complex

The following are tests used to try and document bradycardia except Holter monitor Event recorder Implantable event recorder Implanted permanent pacemaker

Implanted permanent pacemaker

A corrected sinus node recovery time (CSNRT) is characterized by The time it takes for a sinus beat to occur after rapid atrial pacing Subtracting the sinus cycle length from the time it takes a sinus beat to occur after rapid atrial pacing Rapid atrial pacing followed by rapid ventricular pacing. The time it takes to place a pacemaker

Subtracting the sinus cycle length from the time it takes a sinus beat to occur after rapid atrial pacing

An EP study scheduled to diagnose causes of bradycardia would include HRA, HIS and RV catheters HIS, CS, RV and Ablation catheters HRA, CS and Transeptal Halo catheter RVOT, HRA and RVA catheters

HRA, HIS and RV catheters

A junctional escape rhythm is characterized by all of these except A rate of 40-60 A narrow complex QRS rhythm A wide complex paced rhythm A proximal AV nodal block

A wide complex paced rhythm

Baseline EGM measurements are generally performed at what recording speed? 25 mm/second 100 mm/second 200 mm/second 500 mm/second

200 mm/second

Measuring the precise moment in time when the depolarization/activation wave front passes thought the mid-point between an electrode pair, manifested by the apex point of the EGM deflection is known as: Zero-Cross Over Point Approach Onset Approach Isoelectric Approach Gained Approach

Zero-Cross Over Point Approach

Which of the following are common surface ECG intervals measured? PR, A-A, R-R, QRS PR, QRS, QT, P-P, R-R A-A, AH, HV, QRS, V-V A-A, QRS, P-P, R-R, V-V

PR, QRS, QT, P-P, R-R

Which of the following are common EGM intervals measured? PR, A-A, R-R, QRS PR, QRS, QT, P-P, R-R A-A, AH, HV, QRS, V-V A-A, QRS, P-P, R-R, V-V

A-A, AH, HV, QRS, V-V

A normal PR interval is 90 ms 120 ms 220 ms 320 ms

120 ms

A normal QRS interval is 90 ms 125 ms 225 ms 320 ms

90 ms

Which mechanism is defined by (1) slow zone of conduction, (2) unidirectional block in part of the tissue, and (3) slow enough conduction allowing tissue to become refractory? Automaticity Triggered Reentry Foci

Reentry

A normal H-V interval is 20 ms 50 ms 70 ms 100 ms

50 ms

An ABNORMAL A-H interval would be 20 ms 50 ms 70 ms 100 ms

20 ms

What interval measurement could indicate electrolyte disturbances like hypokalemia and hypocalcemia? PR AH RR QT

Bradycardia is defined as a heart rhythm that is slow at a rate below __________. 40 bpm 50 bpm 60 bpm 80 bpm

60 bpm

Failure of the SA Node to adequately generate an appropriate number of intrinsic (native) electrical impulses defines which term? Failure of impulse propagation Failure of impulse generation Automaticity Triggered activity

Failure of impulse generation

Failure of the sufficient electrical impulse propagation by the AV node is known as Failure of impulse propagation Failure of impulse generation Automaticity Triggered activity

Failure of impulse propagation

The intrinsic (natural) ability of cardiac cells to spontaneously and repetitively generate electrical impulse for depolarization is known as Failure of impulse propagation Failure of impulse generation Automaticity Triggered activity

Automaticity

What are the three (3) different mechanisms of activation that propagate tachycardias? Propagation, generation, automaticity Reentry, autocentricity, triggered Generation, reentry, triggered Reentry, triggered, automaticity

Reentry, triggered, automaticity

Which of the following criteria is required for reentry? Slow zone of conduction Slow enough conduction allowing tissue to become refractory Unidirectional block All answers are correct

All answers are correct

Activity which propagates double activation of a cardiac cell from a single initial activation, resulting from the presence of upward deflections is known as which mechanism of activation? Reentry Autocentricity Automaticity Triggered activity

Triggered activity

Delayed after depolarization (DAD) occur in which phase of the action potential of triggered activity? Phase 1 Phase 2 Phase 3 Phase 4

Phase 4

Regarding tachycardias, which is the most common mechanism of activation? Triggered Reentry Intrinsic Automaticity

Reentry

What is the heart rate in beats per minute for a patient with a tachycardia rate of 320 msec? 178 198 188 208

188 bpm 60,0000/320

The formula for cSNRT is: (RCL-BCL)/2 SNRT-SCL (BCL-RCL)/2 SCL-SNRT

SNRT-SCL

Which of the following mechanisms of tachycardia is the most common? Intrinsic Automaticity Reentry Triggered

Reentry

The most common site of triggers for atrial fibrillation is/are the: Pulmonary veins Crista terminalis Pulmonary arteries Eustachian Ridge

Pulmonary veins

Burst pacing protocol consists of delivering which of the following: A premature extra stimuli into a fixed pacing train Decremental pacing stimuli within a pacing train An alternating long short cycle length within a pacing train A fixed sequence pacing train

A fixed sequence pacing train

While advancing the RV catheter, the patient suddenly goes into complete heart block. What would be the most likely explanation for this? The patient has an existing RBBB The patient has an existing LBBB The patient has an existing RBBB and SA nodal sisease The patient has an existing R postero-fasicular BBB

The patient has an existing LBBB

Following successful atrial flutter ablation, the stim to activation time as measured on the distal pole of the multi-pole catheter should measure at least _____ msec. 100 150 50 200

150

What is the most common site for idiopathic VT? The right ventricular outflow tract The left ventricular outflow tract The scar margin from a myocardial infarction The left and right bundle branches

The right ventricular outflow tract

With the exception of a local stimulus of above normal strength, which of the following refractory periods describe the time during repolarization in which the longest coupling interval (S1, S2) of input into a tissue fails to produce capture? Effective Functional Absolute Relative

Effective

Which of the following are appropriate high/low pass filters for intracardiac electrograms in Hertz? 5.0/100 .05/500 30/500 0.5/100

30/500

During cryoablation for atrial fibrillation, which of the following ensures avoidance of phrenic nerve damage? High output pacing during ablation 4-minute ablation sessions Sustained tissue temperatures of 45-50°C 2-minute ablation sessions

High output pacing during ablation

Which one of the following may be a sign of an embolic stroke immediately after a successful transseptal puncture? Presence of a U-wave on ECG ST elevation on leads V1-V2 Facial weakness and drooping on one side of the patient Cessation of a headache

Facial weakness and drooping on one side of the patient

Which of the following is the commonly used needle to obtain transseptal access? BSD needle Brockenbrough needle Seldinger needle Mullen’s needle

Brockenbrough needle

What diagnostic catheter is used to drain the pericardial sac for a pericardiocentesis? JL 4 MPA I JR 4 Pigtail

Pigtail

In a typical bundle branch reentry (BBR) ventricular tachycardia, the reentry signal initiates antegrade down the right bundle branch (RBB) to which of the following to complete the reentry circuit? Retrograde up the right bundle branch (RBB) Retrograde up the left bundle branch (LBB) Retrograde up the accessory pathway (AP) Antegrade down the left bundle branch (LBB)

Retrograde up the left bundle branch (LBB)

Which of the following is MOST appropriate for a 14-year-old female patient who requires an ablation for AVNRT? Laser ablation 4 mm cryoablation 8 mm non-irrigated radio-frequency ablation 3.5 mm irrigated radio-frequency ablation

4 mm cryoablation

All of the following are monitored and documented during a typical tilt table test (TTT) EXCEPT: Oxygen saturation Blood pressure Heart rate ECG rhythm

Oxygen saturation

To minimize the effects of signal artifact or environmental noise, how must all EP lab equipment must be set up? Enable 60 cycle noise filter Combine all EP equipment and control room peripheral equipment onto the same power circuit Keep signal gain to less the 0.5 mV Isolate all EP equipment to a separate designated power circuit

Isolate all EP equipment to a separate designated power circuit

If an atrial flutter cycle length is 280 bpm, then what is the cycle length in milliseconds? 244 ms 241 ms 204 ms 214 ms

214 ms

Ablating which section increases concern and risk for damaging the esophagus? Pulmonary artery Pulmonary veins Posterior LA Lateral LA

Posterior LA

During an AF ablation using the pulmonary vein isolation (PVI) technique, pacing the coronary sinus (CS) will do which of the following? Check for entrance block Check for exit block Check for residual pulmonary vein (PV) signals Verify which pulmonary vein (PV) to ablate

Check for an entrance Block

What is an upper acceptable value for a corrected SNRT? 400 ms 700 ms 540 ms 650 ms

540 ms

What cryo-ablation temperatures cause effective tissue damage and lesion formation? 45 to 65°F 45 to 55°F 45 to 55°C 45 to 65°C

45 to 65°F

Successful flutter ablation should show stimulus to activation conduction time measuring at least: ≤20 ms <120 ms >150 ms >250 ms

>150 ms

Which of the following verifies successful isthmus conduction block for a typical atrial flutter ablation? >250 ms <120 ms ≤20 ms >150 ms

>150 ms

For either one of the current mapping systems, what color setting is used to distinguish healthy tissue during voltage mapping? Purple Red Grey White

Purple

During a tilt table test (TTT), the room should be_________. Accompanied with staff to readily converse with patient for stimulation Well–lit, with all lights on Quiet with lights dimmed to establish a relaxing environment

Quiet with lights dimmed to establish a relaxing environment

The high/low filter setting for intracardiac electrograms is _________. 30/500 Hz 0.5/300 Hz 30/50 Hz 0.5/100 Hz

30/500 Hz

If a tachycardia cycle length is 600 milliseconds, what is its rate in beats per minute? 60 bpm 160 bpm 600 bpm 100 bpm

100 bpm

Activation mapping of a 3D electro-anatomical mapping system provides which of the following? Displays border region of earliest tissue activation, shows early-meets-late patterns Displays cardiac activation morphology for 12-lead comparison Displays the dynamic propagation of an electrical activation wave front Displays the voltage values according to a color spectrum

Displays border region of earliest tissue activation, shows early-meets-late patterns

During RF ablation, a high impedance reading continually shuts off the RF generator. The first troubleshooting attempt should be to: Replace the RF catheter Power down and restart RF generator Check if the patient ground is secure Replace the catheter connector

Check if the patient ground is secure

During monitoring of a radiofrequency ablation procedure, you observe the catheter temperature reach 100 degrees C. What is the next action? Alert the physician and stop the ablation delivery because of potential coagulum Alert the physician and stop the ablation delivery because an adequate lesion is achieved Increase the impedance to decrease the wattage and subsequently the temperature Increase the saline infusion rate of the fluid cooled ablation system

Alert the physician and stop the ablation delivery because of potential coagulum

The technologist is assisting the physician with a PVI. Midway through a burn, microbubbles appear on the ICE image. The technologist should: Lower the power Increase the power Tell the physician to stop burning Tell the physician to move the catheter

Tell the physician to stop burning

What is the usual result of moving the ground patch closer to the site of RF energy? An increase in temperature A decrease in temperature An increase in impedance A decrease in impedance

A decrease in impedance

One of the complications specific to PVI is: Heart block Thromboembolism Cardiac tamponade Atrioesophageal fistula

Atrioesophageal fistula

An impulse that blocks in the fast pathway and conducts through the slow pathway describes which of the following arrhythmias? AVNRT AVRT WPW Complete heart block

AVNRT

The mA of the stimulator is conventionally set at: Half diastolic threshold Diastolic threshold 2x diastolic threshold 3x diastolic threshold

2x diastolic threshold

A conduction impulse that initially blocks down the fast pathway and slowly conducts over the slow pathway to initiate a reentrant rhythm describes which arrhythmia? Afib AVRT AVNRT Accessory Pathway

AVNRT

AVNRT is a micro reentrant tachycardia. TRUE FALSE

True

When viewing a 12 lead ECG of AVNRT, the P-wave may not be present, if present it will occur after the QRS or be called a retrograde P-wave. True False

True

During AVNRT, ECG will display a tachycardia with a rate of 80-120 bpm 150-220 bpm Greater than 300 bpm

150-220 bpm

To terminate AVNRT pharmacologically, what will be the initial dose of adenosine? 3 mg IVP 6 mg IVP 12 mg IVP 24 mg IVP

6 mg IVP

In typical AVNRT, which pathway will a premature beat initially block and then what pathway will the impulse propagate down? Initially block down the fast pathway (FP), then propagate down the slow pathway (SP). Initially block down the slow pathway (SP), then propagate down the fast pathway (FP).

Initially block down the fast pathway (FP), then propagate down the slow pathway (SP).

Conduction occurring down the slow AV nodal pathway and up the fast AV nodal pathway is Typical AVNRT Atypical AVNRT

Typical AVNRT

What non-pharmaceutical technique can also terminate AVNRT? Carotid curling Femoral curling Carotid massage Femoral massage

Carotid massage

A "jump" is defined during extra-stimulus pacing (S1S2) in which decrements of 10 ms on S2 demonstrates a jump in the A2H2 interval of >50ms, indicative of refractoriness in the fast AV nodal pathway. TRUE FALSE

TRUE

In AVNRT, what pacing technique typically reveals the presence of a "jump"? Atrial burst pacing. Decremental ventricular pacing. Programmed atrial stimulation (A1 A2). Pacing the atrium for 30 seconds.

Programmed atrial stimulation (A1 A2).

For an AVNRT ablation, the optimal ratio of atrial to ventricular intracardiac signal (A:V) displayed on the mapping/ablation catheter is 1:1 1:2 1:4 1:10

1:4

Slow junctional rhythm can be a normal finding during an AVNRT ablation. TRUE FALSE

TRUE

Currently, the fast pathway (FP) is routinely ablated for AVNRT ablation. TRUE FALSE

False

Anatomically, the slow pathway is commonly located in the left atrial appendage. right inferior pulmonary vein. coronary sinus os to posterior septum. zone of tissue along the tricuspid annulus posteroinferior to the node.

zone of tissue along the tricuspid annulus posteroinferior to the node.

Where is the fast pathway located? CS os Left atrial appendage Right pulmonary vein Superior to the triangle of Koch

Superior to the triangle of Koch

A beat that returns to its origin and is actually a single beat of reentrant tachycardia that failed to sustain AVNRT is known as _______________. a fusion beat a jump an echo beat triggered beat

an echo beat

AVNRT can be initiated with which of the following pacing maneuvers? Atrial burst pacing. Decremental ventricular pacing. Pacing the atrium for 30 seconds. Premature atrial pacing, also called extra-stimulus pacing.

Premature atrial pacing, also called extra-stimulus pacing.

What is the most common form of SVT? AVRT AVNRT Wolff Parkinson White Flutter

AVNRT

In AVRT, a delta wave is produced as a result of Antegrade accessory pathway (AP) conduction which pre-excites ventricular tissue. Retrograde accessory pathway (AP) conduction which pre-excites atrial tissue. Antegrade AV Node conduction which pre-excites ventricular tissue. Retrograde AV Node conduction which pre-excites atrial tissue.

Antegrade accessory pathway (AP) conduction which pre-excites ventricular tissue.

Which best describes a "manifest" accessory pathway (AP)? Presence of a delta wave preceding the QRS complex surface ECG. Normal conduction down the AV Node and then up the accessory pathway. Conduction up the pathway or in the retrograde direction. (from V to A).

Presence of a delta wave preceding the QRS complex surface ECG.

An Accessory Pathway (AP) with antegrade conduction, displaying a pre-excited delta wave, is known as Wolff-Parkinson-White (WPW) syndrome. TRUE FALSE

TRUE

Concealed accessory pathways conduct both antegrade and retrograde conduction, resulting in short PR intervals. TRUE FALSE

FALSE

Orthodromic tachycardia is defined as tachycardia with normal conduction down the AV node and then up the accessory pathway. tachycardia in which the conduction travels down the accessory pathway and then up the AV node. Initially block down the fast pathway (FP), then propagate down the slow pathway (SP). Initially block down the slow pathway (SP), then propagate down the fast pathway (FP).

tachycardia with normal conduction down the AV node and then up the accessory pathway.

Antidromic tachycardia is defined as tachycardia with normal conduction down the AV node and then up the accessory pathway. tachycardia in which the conduction travels down the accessory pathway and then up the AV node. Initially block down the fast pathway (FP), then propagate down the slow pathway (SP). Initially block down the slow pathway (SP), then propagate down the fast pathway (FP).

tachycardia in which the conduction travels down the accessory pathway and then up the AV node.

During manifest activation, the delta wave will become more prominent as more of the ventricle is activated via the accessory pathway during rapid atrial pacing (burst pacing). TRUE FALSE

TRUE

If delta wave in V1 is negative on your 12 lead ECG, where is the accessory pathway located? Right side Left side Indeterminate Septum

Right side

AVRT is a _____________ circuit. micro reentry macro reentry Triggered micro automaticity

macro reentry

A Mahaim Fiber is a type of AP located similarly to the AV node on the tricuspid annulus and displays decremental properties, directly connecting to the fascicle of a bundle branch rather than the ventricle like the typical AV nodal accessory pathway. TRUE FALSE

TRUE

The following components are necessary to complete an AVRT circuit. Atria, AV Node, AP AP, AV Node, Ventricle Atria, AV Node, Ventricle, AP Atria, micro reentrant circuit, AV node, AP

Atria, AV Node, Ventricle, AP

In "orthodromic AVRT", is the QRS complex narrow or wide? Wide (pre-excited) Narrow

Narrow

In "antidromic AVRT", is the QRS complex narrow or wide? Wide (pre-excited) Narrow

Wide (pre-excited)

A patient in AVRT has a V-A time of 165 ms. The patient then develops a left bundle branch block (LBBB) and the V-A times jumps +50 ms, patient most likely has ________________. right sided accessory pathway (AP) left sided accessory pathway (AP) atypical AVNRT atypical flutter

left sided accessory pathway (AP)

The most common catheter position and sites when performing a diagnostic EP study for ventricular tachycardia (VT) are HRA, HIS, LA HRA, HIS, CA, LV, LVOT HRA, HIS, CS HRA, HIS, RVA, RVOT

HRA, HIS, RVA, RVOT

Damaged cardiac tissue as a result of diminished or no blood supply describes which type of cardiac disease tissue? Idiopathic Ischemic

Ischemic

This is the most common site for idiopathic VT is the LVOT. RVA. aortic cusp.

RVOT

VT is considered "sustained" when it is maintained for 3 beats 5 beats 15 sec 30 sec

30 sec

If a patient has VT and is shocked at 22 seconds because the patient is hemodynamically unstable, the VT is considered sustained. TRUE FALSE

True

This chamber is the most susceptible to ischemic, scar based VT's RV LV Equal

The condition where fatty tissue infiltrates or fibrous tissue replaces normal myocardial tissue of the RV is known as Long QT syndrome (LQTS) Brugada syndrome Idiopathic dilated cardiomyopathy (ILVT) Arrhythmogenic Right Ventricular Dysplasia (ARVD)

Arrhythmogenic Right Ventricular Dysplasia (ARVD)

Which of the following are reentrant criteria for reentrant VT? conduction around an in-excitable obstacle zone of slow conduction pathway of unidirectional block All are correct

All are correct

This is a genetic disorder that affects the ion channels (sodium, potassium) of cardiac cells and can result in an arrhythmia called torsade's de points Long QT syndrome (LQTS) Brugada syndrome Idiopathic dilated cardiomyopathy (ILVT) Arrhythmogenic Right Ventricular Dysplasia (ARVD)

Long QT syndrome (LQTS)

These devices have been proven to reduce mortality of selected patients at risk for sudden cardiac death is Permanent pacemaker (PPM) Bi-ventricular pacemaker (Bi-V) Implantable cardioverter-defibrillators (ICD's) Loop recorder

Implantable cardioverter-defibrillators (ICD's)

Patients with Brugada syndrome will usually present with a right bundle branch block (RBBB). TRUE FALSE

TRUE

Patients with Brugada syndrome will present with subtle ST segment elevation in II, II, AVF V1-V3 II, AVF V3-V5

V1-V3

The interval of time in milliseconds (ms) between two cardiac electrical stimuli or paced beats is known as Cycle length Coupling interval Capture

Coupling interval

A drive train has a series of 6-8 paced beats at a fixed cycle length is considered known as S1 S2 S3 S4

When evaluating the sinus node function, an abnormal CSNRT value would be 275 ms 375 ms 475 ms 575 ms

575 ms

SNRT assessment is performed by pacing the atrium for 30 sec and measuring last paced "A" to first intrinsic "A". pacing the atrium for 3 sec and measuring last paced "A" to first intrinsic "A". S1 drive train pacing for 90 sec, add S2 and measuring the last paced S2 to first intrinsic "A". S1 drive train pacing for 90 sec, add S2 and measuring last paced S2 to first intrinsic "V".

pacing the atrium for 30 sec and measuring last paced "A" to first intrinsic "A".

H-V conduction interval of 23 ms is considered a normal value. True False

False

The longest coupling interval of a premature stimulus which does not conduct through to the AV node is known as AERP AVNERP VERP VAERP

AVNERP

The longest coupling interval for a premature stimulus which does not conduct to depolarize ventricular tissue. AERP AVNERP VERP VAERP

VERP

Normal H-V conduction interval is 15 - 25 ms 35 - 55 ms 75 - 95 ms 100-120 ms

35 - 55 ms

Electrical stimuli that causes depolarization of the chamber being stimulated is known as capture. threshold. sensitivity. chronaxie.

capture

The minimum current needed to capture a chamber with pacing stimulus is known as capture. threshold. sensitivity. chronaxie.

threshold.

When incremental burst pacing (S1) faster until loss of 1:1 ratio in AV conduction is noted, the longest S1 coupling interval that fails to conduct 1:1 is known as which of the following? SACT SNRT CSNRT Wenckebach

Wenckebach

Burst pacing is _____________________. introduction of one or more premature paced beats (extra-stimulus) at a shorter cycle length after the proceeding pacing train which is a fixed cycle length pacing while adjusting the cycle length in small increments (10-50 ms) pacing at a fixed cycle length all are correct

pacing at a fixed cycle length

Introduction of one or more premature paced beats (extra-stimulus) at a shorter cycle length after the proceeding pacing train which is a fixed cycle length (S1, S2), is which type of pacing? Burst Decremental Incremental Programmed Extra-Stimulus (PES)

Programmed Extra-Stimulus (PES)

When burst pacing the RVA via an EP catheter, the pacing output should be set to at least _____________________. less than 0.5 mA less than 1.0 mA 0.5 more than threshold determination 1.0 mA more than threshold determination

1.0 mA more than threshold determination

What condition may lead to complete heart block while advancing an EP catheter to the right ventricular apex? Right bundle branch block (RBBB) Left bundle branch block (LBBB) Right sided accessory pathway (AP) Left sided accessory pathway (AP)

Left bundle branch block (LBBB)

RV pacing with proper capture produces an ECG morphology resembling__________________. right bundle branch block (RBBB) Left bundle branch block (LBBB) polymorphic ventricular tachycardia tri-fascicular block

Left bundle branch block (LBBB)

When performing threshold determination, stimulus output is conventionally set to a minimum of at least 3 mA or: 1 mA the point of tissue capture 2x threshold minimum 3x threshold minimum

2x threshold minimum

A typical drive train consists of 1 beat 4 beats 8 beats 12 beats

8 beats

Ventricular arrhythmia induction is assessed with incremental pacing. decremental pacing burst pacing. PES pacing.

PES pacing.

Dual AV node physiology is assessed with incremental pacing. decremental pacing burst pacing. PES pacing.

PES pacing.

Atrial tachycardias may be difficult to initiate, however the most effective pacing maneuver is incremental pacing. burst or decremental pacing. PES pacing.

burst or decremental pacing.

What should the next step be in trouble shooting when the ablation generator shuts off with a 'high impedance' error message? Replace the ablation cable. Replace the ablation catheter. Restart the EP recording system. Ensure the grounding pad is properly applied to the patient.

Ensure the grounding pad is properly applied to the patient.

When performing an ablation with an open irrigated ablation catheter, what must be done when the irrigation pump alarms? Stop the pump and flush bolus flush the pump at 30 cc/minute. Titrate the irrigation rate to 8cc from 15cc on the irrigation pump. Reset the alarm parameter on the irrigation pump. Stop the pump and notify the performing physician.

Stop the pump and notify the performing physician.

What is the primary cause of temperatures observed over 100 degrees Celsius during radio-frequency ablation? Resistive heating Conductive heating Catheter tip coagulum & char Excessive irrigation rate

Catheter tip coagulum & char

The common tip size for a Cryoablation catheter tip is: 4 mm 6 mm 8 mm 10 mm

4 mm

If bubbles are observed on intra-cardiac ultrasound (ICE) during left sided ablation, the EP staff should: Stop the pump and flush bolus flush the pump at 30 cc/minute. Titrate the irrigation rate to 8cc from 15cc on the irrigation pump. Reset the alarm parameter on the irrigation pump. Stop the pump and notify the performing physician.

Stop the pump and notify the performing physician.

What is the next step if a patient 's rhythm changes to complete heart block during ablation near the His bundle? Stop the ablation. Stop ablation and wait for normal conduction to begin before resuming ablation. Start ventricular pacing or prep for temporary pacing. Stop ablation and start ventricular pacing or prep for temporary pacing.

Stop ablation and start ventricular pacing or prep for temporary pacing.

An effective lesion formation during radio-frequency ablation (RFA) is marked by: Decrease in impedance, 5-10 ohms. Increase in impedance, 5-10 ohms. No change in impedance. Moving the grounding pad closer to the heart will likely result in:

Decrease in impedance, 5-10 ohms.

Moving the grounding pad closer to the heart will likely result in: Decrease in impedance (ohms). Increase in impedance (ohms). Decrease in temperature (Celsius) Increase in temperature (Celsius)

Decrease in impedance (ohms).

A severe complication to left atrial ablation that is often monitored for is: Esophageal fistula Thromboembolism Cardiac tamponade Complete heart block

Esophageal fistula

Which of the following determines the size of the myocardial lesion during ablation? Impedance The location of the indifferent electrode (grounding patch) The size of the distal electrode & the amount of energy delivered All are correct

The size of the distal electrode & the amount of energy delivered

A successful endpoint for a ‘typical’ isthmus dependent atrial flutter ablation, is an increase in the trans-isthmus conduction post pacing interval (PPI) of at least: 10 ms 100 ms 150 ms 250 ms

150 ms

What situation would require the use of a 10-mm tip and / or high-output 100-watt generator for ablation? Slow pathway ablation in AV Node modification. Creating a lesion on the posterior left atrial wall. When a larger myocardial lesion is desired, i.e. thicker tissue like the isthmus and ventricular tissues. Atrial fibrillation ablation.

When a larger myocardial lesion is desired, i.e. thicker tissue like the isthmus and ventricular tissues.

In a ‘typical’ atrial flutter (AFL) case, post ablation endpoint must prove the septum is now no longer part of the circuit. the flutter cycle length is now slower. the flutter is now atypical. bidirectional block has occurred across the area where ablation was performed.

bidirectional block has occurred across the area where ablation was performed.

What nerve should be considered when ablating the lateral regions of the right heart? Phrenic Nerve Vagus Nerve Trigeminal Nerve Diaphragmatic Nerve

Phrenic Nerve

All of the following are ultrasound modalities EXCEPT TTE TEE EFT ICE

EFT

Which type of ultrasound can be done the same day without need for sedatives? TTE TEE EFT ICE

TTE

Intracardiac Echo (ICE) is usually introduced to the heart via the esophagus. internal jugular vein. femoral artery. femoral vein.

femoral vein

The functional part of an ultrasound probe is the referred to as the Oscillator Anode Rotor Transducer

Transducer

Positioning the ICE catheter in the RA, just above the terminal end of the IVC, with the transducer oriented with a leftward-anterior transducer face yields which of the following views? Home view Lateral view RVOT view Transeptal view

Home view

After insertion of the ICE imaging catheter, which maneuver sets up imaging for transseptal access? clockwise rotation from home view counterclockwise rotation from home view

clockwise rotation from home view

Visual presentation of ultrasound in which the depth of echo is displayed along one axis and time is displayed along a second axis, recording ‘motion’ of interfaces away and towards the transducer is known as Doppler 3D Doppler M-Mode Axis Mode

M-Mode

The technology of ultrasound using the high frequency sound waves to image, measure and calculate blood flow is known as Doppler 3D Doppler M-Mode Axis Mode

Doppler

Aspiration is a usual complication of which type of ultrasound modality? TTE TEE EFT ICE

TEE

During afib ablations, ICE is used to visualize all of the following EXCEPT Blood flow velocities Ejection fraction Guiding transseptal puncture Identification of procedural complications

Ejection fraction

The following systems are 3D mapping systems EXCEPT: Hansen Carto Rhythmia LocaLisa

Hansen

3D electro-anatomical mapping systems display a variety of unique mapping techniques that include voltage mapping activation mapping propagation mapping All the above

All the above

In voltage mapping, voltage values of <1.5 mV is considered abnormal cardiac tissue, and values <0.5 mV is considered Propagation Activation Scar All the above

Scar

On the CARTO mapping system, low voltage will be depicted in which color? Red Purple Blue White

Red

The technique that utilizes a recorded ECG/EGM of a cardiac activation morphology generated by an arrhythmia to be compared against paced activation morphologies in attempts to reproduce and match morphologies, which identifies the origin of the arrhythmia is known as Entrainment mapping activation mapping propagation mapping pace mapping

pace mapping

The mapping technique that requires the advancement of the tachycardia rate to that of the paced cycle length without altering the morphology of the tachycardia is entrainment mapping activation mapping propagation mapping pace mapping

pace mapping

What is the corrected QT (QTc) for a patient with a QT of 300 ms and R-R interval of 750 ms? 0.3 0.35 0.41 2.5

0.35

What is the heart rate (HR) of a sinus cycle length at 800ms? 65 bpm 72 bpm 75 bpm 80 bpm

75 bpm

What is the corrected sinus node recovery time (cSNRT) for a sinus node recovery time measured at 1395 ms and a sinus cycle length measured at 775ms? 620 ms 675 ms 2170 ms 2945 ms

620 ms

What is the formula to calculate corrected sinus node recovery time (cSNRT)? SNRT – SCL SNRT - SCL/2 SCL + SNRT SCL - PPI/2

SNRT – SCL

A SNRT is 1450 MS. The Sinus Cycle length is 850 ms. What is the CSNRT? 320 ms 600 ms 750 ms 1200 ms

600 ms

Which of the following is Ohms Law? V= IR I=VR V=R/I V= I/R

V= IR

Which of the following is not a correct expression of Ohms Law? V= IR R= V/I I= V/R V= I/R

V= I/R

What is the cycle length of a beat of a patient with a heart rate (HR) of 150 bpm? 150 ms 250 ms 400 ms 1500 ms

400 ms

What are common high/low pass filter settings for SURFACE lead ECGs of a typical EP recording system? 0.5-100Hz 30-50 Hz 30-500 Hz 0.5-300 Hz

0.5-100Hz

What are common high/low pass filter settings for INTRACARDIAC electrograms (EGMs) of a typical EP recording system? 0.5-100Hz 30-50 Hz 30-500 Hz 0.5-300 Hz

30-500 Hz

Which of the following best describes Low amplitude/frequency? Cardiac tissue re-polarizations, which are displayed and represented by long and dull signal frequencies and deflections. Cardiac tissue depolarizations displayed and represented by sharp and discrete signal frequencies and deflections. A measure of desired signal compared to the level of background noise expressed in a ratio.

Cardiac tissue re-polarizations, which are displayed and represented by long and dull signal frequencies and deflections.

The filter setting that eliminates signal below a set frequency threshold or cut-off, allowing high frequencies to pass through the set cut off is which of the following? Notch filter Clipping High band pass filter Low band pass filter

High band pass filter

The limiting of EGM signal amplitude (positive & negative), reducing signal overlapping of EGM’s is best achieved by which of the following? Notch filter Clipping High band pass filter Low band pass filter

Clipping

Which of the following filters eliminates electronic signal noise of 60 Hz that is inherent in North American alternating current? Notch filter Clipping High band pass filter Low band pass filter

Notch filter

Typical High Pass EP recording system filtering is generally set at which values? 0.5-100 Hz 30-50 Hz 100-300 Hz 300-500 Hz

30-50 Hz

Typical Low Pass EP recording system filtering is generally set at which values? 0.5-100 Hz 30-50 Hz 100-300 Hz 300-500 Hz

300-500 Hz

Far-field signals are EGM signals recorded from localized tissue in contact between two catheter electrode pairs, displaying a narrow and sharp signal deflections. TRUE FALSE

FALSE

EGM signals recorded from localized tissue in contact between two catheter electrode pairs, displaying a narrow and sharp signal deflections is best described as which of the following? Near-field Far-field Low amplitude/frequency High amplitude/frequency

Near-field

Which of the following indications would LEAST likely result in a pacemaker? Complete Heart Block Sinus Bradycardia Symptomatic Mobitz Type I Symptomatic Mobitz Type II

Sinus Bradycardia

The physician is using the laser to extract an RV pacing lead with he notices a snowplowing effect. The BEST next step would be to Upsize the laser sheath by one French size Downsize the laser sheath by one French size Try a Byrd workstation from the groin Take out laser sheath and apply more traction to the locking stylet Incorrect

Upsize the laser sheath by one French size

Cellular telephones: Never inhibit pacing May be carried in the contralateral breast pocket Cause greater interference in bipolar pacing systems Will permanently damage pacemakers if held in close proximity to the device

May be carried in the contralateral breast pocket

Pacing thresholds are not influenced by: Maturation process Electrode material Electrode surface area Insulation material

Insulation material

Lead conductor fracture typically results in: Low impedance High impedance Increased sensitivity Decreased sensitivity

High impedance

Resistance is measured in: Amperes Volts Millivolts Ohms

Ohms

The patient arriving for their pacemaker implant is complaining of itching and feeling warm. The IV Ancef was started by the floor nurse approximately 20 minutes ago. What immediate action should be taken? Notify the physician immediately Give 50 mg IV Diphenhydramine Stop the Ancef drip and notify the physician Do nothing until the physician arrives

Stop the Ancef drip and notify the physician

A pacemaker would be necessitated for a patient with: Mobitz Type I heart block at 120 BPM Symptomatic 1st degree heart block with HIS purkinje disease Wenckeback block at 380 msec Syncope in the setting of hypovolemia

Symptomatic 1st degree heart block with HIS purkinje disease

At the time of implant, the atrial sensing threshold should be at least _____ mV. 0.5 1.0 1.5 2.0

0.5

Magnet application to an internal cardiac defibrillator closes the Reed switch which disables: Pacing Pacing and shocking therapies Arrhythmia detection Shocking therapies

Shocking therapies

Which of the following is the MOST important consideration when selecting a sit for a peripheral IV in a patient undergoing a device impant? Patient preference Length of hospital stay Planned side of implant Type of intravenous fluid

Planned side of implant

A properly functioning RV apical pacing lead should produce a _____ morphology on the surface ECG. LBBB RBBB Bi-fasicular block Tri-fasicular block

LBBB

While providing patient education post-pacer implant, signs of pacemaker malfunction should include: Dizziness, dyspnea, angina, peripheral edema, return of previous symptoms Dizziness, palpitations, dyspnea, dysphagia Syncope, muscle twitch, redness around pacemaker pocket Syncope, angina, shortness of breath, hyperventilation, hiccoughs

Syncope, angina, shortness of breath, hyperventilation, hiccoughs

Which of the following safety checks should be performed prior to using a temporary pacemaker for pacing? Threshold checks should be done The pacemaker should be gas sterilized Check date of last battery change Terminal pins should be checked by an ohm meter

Check date of last battery change

What effect describes the fact that the pacing threshold is usually lower when measured by gradually decrementing stimulus output instead of increasing stimulus output for lead threshold testing? Wedensky Hysteresis Bernoulli Chronaxie

Wedensky

Which impedance value of a newly implanted RV lead is considered a normal value? 100 Ω 200 Ω 700 Ω 1700 Ω

700 Ω

When testing a right ventricular (RV) lead implanted in the right ventricular apex, stimulation of the RV by the RV lead will resemble which of the following morphology patterns on ECG? Narrow QRS with U-wave Right bundle branch block (RBBB) Left bundle branch block (LBBB) Ventricular ectopic beats (VEBs)

Left bundle branch block (LBBB)

After failed DFT testing from subsequent RV lead repositioning, the MOST appropriate next step is: Set a higher DFT Enable both burst and ramp ATP pacing Increase the atrial sensing crosstalk Reverse shocking polarity

Reverse shocking polarity

Prior to using a temporary pacemaker, what should be checked first? Battery indicator status Date of last check Whether it is in synchronous or asynchronous pacing mode Compatibility with pacing cables

Date of last check

In preparing for a new ICD device implant, which vessel has a greatest risk of pneumothorax when obtaining vascular access? Subclavian Jugular Axillary Cephalic

Subclavian

During a pulse generator replacement procedure for ERI, you notice that one RV lead is capped with sutures and another RV lead is securely connected to the device header. What is the next appropriate step? Proceed with the generator change as normal Uncap the RV lead and test sensing and threshold Uncap the RV lead, disconnect the other RV lead, and test both All are correct answers

Proceed with the generator change as normal

When preparing to perform a lead extraction procedure for a chronic lead, which of the following is the MOST critical? Surgical team standby Temporary pacemaker setup Pericardiocentesis tray Thoracotomy tray

Surgical team standby

In switching a temporary pacemaker from demand mode to asynchronous mode, what adjustment is made? Decreased sensitivity Increased sensitivity Decreased threshold Increased threshold

Increased sensitivity

After the right ventricular (RV) lead is positioned and fixated, what is next? Conduct threshold determination again Irrigate the pocket Suture the proximal portion of the RV lead into the device pocket Connect the RV lead to the device header

Conduct threshold determination again

What is the first thing an RN/Technologist should do before handing the laser lead over to the performing physician? Calibrate the laser machine Angle the protective lead shield to 45 degrees Up-size the sheath Secure the locking stylet

Calibrate the laser machine

Impedance (resistance) is measured in which value? Volts Ohms mA Watts

Ohms

What statement describes threshold of a device implant lead? The minimum number of milliseconds (ms) required to elicit a response from the chamber paced. The maximum number of ohms required to elicit a response from the chamber paced. The minimum amount of mA required to elicit a response from the chamber paced. The maximum amount of mA required to elicit a response from the chamber paced.

The minimum amount of mA required to elicit a response from the chamber paced.

Which is the most appropriate protocol for testing the capture threshold of a newly implant atrial lead? Decrease pulse voltage from 5V until loss of capture. Increase the pulse width from 0.5ms until capture. Increase pulse voltage from 0.5V until capture. Decrease the pulse width from 1.5ms until loss of capture.

Decrease pulse voltage from 5V until loss of capture.

Which statement best describes "sensing" of a pacemaker? Pulse amplitude, or height (measured in mV) and its pulse duration or width (measured in ms).? The point at which twice the voltage value meets the strength duration curve, providing a safety margin for capture. The point at which the plateau begins and roughly establishes the minimum voltage requirements to capture the heart. The device's ability to recognize the intrinsic conduction from the patient's heart.

The device's ability to recognize the intrinsic conduction from the patient's heart.

Which of the following statements best describes "chronaxie" of the strength duration curve? Pulse amplitude, or height (measured in mV) and its pulse duration or width (measured in ms).? The point at which twice the voltage value meets the strength duration curve, providing a safety margin for capture. The point at which the plateau begins and roughly establishes the minimum voltage requirements to capture the heart. The device's ability to recognize the intrinsic conduction from the patient's heart.

The point at which twice the voltage value meets the strength duration curve, providing a safety margin for capture.

Capture is simply described as cardiac endocardium depolarization in response to electrical energy from the pulse generator. TRUE FALSE

TRUE

Which feature triggers rate algorithms to increase pacing rate to accommodate for physical demand? Magnetic Ball Sensor Minute Ventilation Sensor Hysteresis Piezoelectric Crystals Sensor

Piezoelectric Crystals Sensor

End of Life (EOL) of a lithium-iodine pacemaker battery is considered once the battery reaches which one of the voltage values? 1.2 V 1.8 V 2.8 V 3.2 V

1.8 V

Which of the following is NOT programmable in a pacemaker? Sensitivity Pulse width Lead polarity Refractory periods

Refractory periods

Which of the following has NO effect on 'pacing thresholds'? steroid tip lead type of lead insulation material lead tissue contact lead insulation break

type of lead insulation material

Low impedance of a device lead during follow up in a pacemaker clinic most likely is a result of: normal values insulation break lead fracture device ERI

insulation break

A lead fracture should be suspected of a device implant lead with an impedance increase of ____________________. 100 ohms 200 ohms 1000 ohms 1200 ohms

1000 ohms

Normal lead impedance range is: 0.05 - 1.5 30 - 50 50 - 500 300 - 1500

300 - 1500

On a pacemaker dependent patient, why would NO pacing occur while the device is out of the pocket even though ALL leads are correctly connected to the device generator? The device is unipolar. The pulse width is set as 2.0ms. The device is bipolar. The pulse width is set as 2.5ms

The device is unipolar.

In an acutely implanted pacemaker, ideal atrial sensing values should be at least _______________. 0.5mV 1.0mV 1.6mV 3.6mV

1.6mV

Bipolar pacemaker leads can NOT be programmed as a unipolar lead. TRUE FALSE

FALSE

What is the normal lead impedance range for a newly inserted typical right atrial lead? 100 - 200 Ω (ohms) 300 - 500 Ω (ohms) 300 - 1,500 Ω (ohms) 900 - 2,000 Ω (ohms)

300 - 1,500 Ω (ohms)

During the lead maturation process, what happens to the implanted lead? Lead sensitivity will decrease below 1.5mV. Insulation is prone to lead fracture. Threshold values decrease below level of implant (non-steroid). Impedance increases as the fibrotic capsule forms, and then levels out as the lead matures.

Impedance increases as the fibrotic capsule forms, and then levels out as the lead matures.

The ideal Sensitivity setting for the right atrium is 0.5 - 1 mV 2 - 3 mV 4 - 40 mV 15 - 20 mV

2 - 3 mV

Select the adjustment that will change a temporary pacemaker from demand to asynchronous mode. Increased sensitivity Decreased sensitivity Increased mA Decreased mA

Decreased sensitivity

Pacing from a RV lead positioned at the apex will produce a morphology similar to RBBB LBBB VF Bigeminy

LBBB

The ideal Sensitivity setting for the right ventricle is 0.5 - 1 mV 2 - 3 mV 4 - 40 mV 15 - 20 mV

4 - 40 mV

Hysteresis is a programmable rate utilized to do which of the following? Therapy to treat SVT's and VT's. Synchrony of a dual lead pacemaker. Initiate overdrive pacing. Promote intrinsic pacing.

Promote intrinsic pacing.

Which scenario is MOST likely to necessitate a pacemaker? Syncope induced by orthostatic hypotension. Non-Symptomatic, Wenckebach, 45 bpm. Symptomatic, 1st degree heart block, 42 bpm. Non-symptomatic Mobitz I, 47 bpm.

Symptomatic, 1st degree heart block, 42 bpm.

Which scenario is LEAST likely to necessitate a pacemaker? Sinus bradycardia 3rd degree heart block Symptomatic, 1st degree heart block, 42 bpm Symptomatic Mobitz I, 47 bpm

Sinus bradycardia

A device feature of pacing to terminate an arrhythmia prior to defibrillation is known as Detection DFT NIPS ATP

ATP

Determining the number of joules necessary to successfully terminate VT/VF mentioned utilizing the patients implanted device is known as Detection DFT NIPS ATP

DFT

The feature of rapid pacing at progressively shorter intervals during ATP is known as Incremental pacing PES Burst pacing Ramp pacing

Ramp pacing

Prior to utilizing a temporary pacemaker, what safety check must be performed? Date of last battery change. Sync vs Demand mode setting. Sterility of temporary pacing cables. Ohm rating.

Date of last battery change.

Which of the following features describes a programmable rate that devices use to promote intrinsic pacing? Magnetic Ball Sensor Minute Ventilation Sensor Hysteresis Piezoelectric Crystals Sensor

Hysteresis

The first letter of the NBG code describes the rate modulation of the device. describes the response by device to a sensed event. represents the chamber or chambers in which the device senses or detects signals. represents the chamber or chambers that are paced by the device.

represents the chamber or chambers that are paced by the device.

The second letter of the NBG code describes the rate modulation of the device. describes the response by device to a sensed event. represents the chamber or chambers in which the device senses or detects signals. represents the chamber or chambers that are paced by the device.

represents the chamber or chambers in which the device senses or detects signals.

The third letter of the NBG code describes the rate modulation of the device. describes the response by device to a sensed event. represents the chamber or chambers in which the device senses or detects signals. represents the chamber or chambers that are paced by the device.?

describes the response by device to a sensed event.

"O" of the NBG code indicates None Single Inhibited Triggered

None

"I" of the NBG code indicates None Single Inhibited Triggered

Inhibited

Which mode represents asynchronous ventricular pacing with no sensing. AAI VOO DDI DDD

VOO

Which mode represents dual chamber pacing & sensing? AAI VOO DDI DDD

DDD

After an ICD implant, when may the patient may resume normal exercise? after 24 hours after 72 hours in one week as their physician advises

as their physician advises

According to the FDA, education on cell phone use with pacemaker patients must state that: Cellphones have no effect on pacemakers. Smart phones may trigger DOO mode. Place the cell phone in their pocket opposite to the side of the implanted device and hold the cell phone to hear on the opposite side of the implanted device. Smart phones interfere with bipolar pacing configurations.

Place the cell phone in their pocket opposite to the side of the implanted device and hold the cell phone to hear on the opposite side of the implanted device.

A patient complains of feeling 'hot and itchy' after receiving 15 min. of antibiotic IV therapy. What is the most appropriate next step? Decrease the IV infusion rate to 1/2. Increase the IV infusion rate 50% of initial infusion rate. Notify the performing MD. Stop the IV infusion and notify the performing MD.

Stop the IV infusion and notify the performing MD.

What diagnostic exam should be ordered after a device implant utilizing a subclavian vein puncture for vessel access? Chest x-ray Echocardiogram ACT INR

Chest x-ray

The technology that allows an ICD to have it shocking therapies disabled when a magnet is applied is the Minute ventilation sensor Reed switch Magnetic ball sensor Piezoelectric crystals sensor

Reed switch

In pre-op prep of a patient undergoing an ICD implant, what is the primary consideration of an IV site placement? Type of antibiotic allergy. Length of expected procedure duration. Type of antibiotic medication administered pre-operatively. Side of device implantation.

Side of device implantation.

Signs of an improperly functioning pacemaker immediately after the procedure would be: Dizziness, palpitations, redness at IV site. Dizziness, angina & shortness of breath. Syncope, redness around implant site, diaphragmatic stimulation. Syncope, hives on the patient’s chest, muscles twitch.

Dizziness, angina & shortness of breath.

This approach requires a more surgical skill since this technique calls for deeper cutting and separation of the fascia and muscles in order to directly identify and isolate the vessel for direct access. Seldinger Cutdown Subclavian Axillary

Cutdown

This method is where the vein is accessed only once, by the one access stick from the needle, and the introducer sheath is inserted over the guide wire and into the vessel. The dilator of the sheet is removed and a second guide wire is placed into the sheath. Then the sheath is removed, freely exposing the guide wires. 2 Sticks Stick, retain guide wire 1 stick, 2 guide wire 1 Stick, 1 guide wire

1 stick, 2 guide wire

Which sutures are absorbable? Ehticon Monocryl Vicryl Both Monocryl and Vicryl

Both Monocryl and Vicryl

Absorbable sutures are normally absorbed into the patient’s tissues between 3 – 5 days 7 – 14 days 30 – 60 days 90 – 120 days

90 – 120 days

Post device implant instructions typically include which of the following? No lifting for 14 days Keep incision site dry for 48 hours No driving for 72 hours All are correct answers

All are correct answers

Signs of pacemaker malfunction may include Dizziness Palpitations Shortness of breath (SOB) All are correct answers

All are correct answers

Cell phones are capable of producing electro-magnetic interference (EMI) and may have an effect on the pacemaker if the mobile phone is in close proximity to the implanted device. TRUE FALSE

TRUE

Before using the laser lead sheath for lead extraction, which item should be utilized first for lead removal? Locking stylet Stepwise sheath Stepwise stylet Suture basket

Locking stylet

During a laser lead extraction procedure, the physician encounters a 'snowplowing' effect. The most appropriate step is Pull harder on the stylet. Use a stepwise sheath. Downsize laser sheath. Upsize the laser sheath.

Upsize the laser sheath.

The best source for correctly sourcing the proper laser sheath size for a specific lead size will be Device lead manufacturer Device lead rep Referring physician SLS Reference Guide

SLS Reference Guide

All of the following are Class I indications for trans-venous lead extraction except: 52 yr. old male with definite ICD system infection. Non-functioning lead in female adolescent. Life threatening arrhythmias secondary to retained lead fragment. Patient with clinically significant thromboembolic events associated with thrombus.

Non-functioning lead in female adolescent.

Class I recommendations for the extraction of chronic pacing and defibrillation leads include all of the following EXCEPT: Life threatening arrhythmias due to a retained lead fragment A lead that interferes with the treatment of a malignancy Non functional leads in a young patient An occult infection for which no source can be found and for which the pacing system is suspected

Non functional leads in a young patient

Just prior to using the laser sheath for lead extraction, a _____ should be used first to attempt removal. Manufacturer’s stylet Locking stylet Byrd suture Ligature tie

Locking stylet

All of the following functions are programmable in both VVI and DDD pacemakers EXCEPT: Sensitivity Sensitivity Refractory periods Voltage output

Refractory periods

What does a low impedance reading mean during a follow up visit post pacemaker implant? Possible lead dislodgeme Possible lead insulation break Normal pacemaker function Normal fluctuations are expected

Possible lead insulation break

ICD conductor fracture should be suspected when there is an impedance increase of: 250 ohms 500 ohms 1000 ohms 1500 ohms

1000 ohms

Hysteresis is used to: Prevent intrinsic conduction Promote intrinsic conduction Promote atrial pacing Promote ventricular pacing

Promote intrinsic conduction

Which of the following BEST describes the threshold for a single chamber implantable pacemaker? The minimum amount of mA required to elicit a response from the chamber paced The maximum amount of mA to block the normal sinus rate The amount of time between pacemaker discharge cycles The minimum amount of voltage to overdrive the normal sinus rate

The minimum amount of mA required to elicit a response from the chamber paced

Which of the following tests should be ordered after subclavian venous puncture? Bloodwork Electocardiogram Echocardiography Chest X-ray

Chest X-ray

A patient presents with an infected ICD pocket. To prepare for a laser lead extraction, the BEST source to find lead sizing information for a laser sheath is the: SLS reference Device Clinic Lead manufacturer Physician

SLS reference

Which of the following is likely to happen during the lead maturation process? Insulation fracture Electrode surface deterioration Decrease in threshold, to a level below that of implant Encapsulation of the electrode with fibrin tissue

Encapsulation of the electrode with fibrin tissue

Which of the following best describes the appropriate protocol for testing the pacing capture threshold of a newly implanted lead? Increasing the pulse width from 0.1 msec until capture is achieved Increasing the pulse voltage from 0.01 msec until capture is achieved Decreasing the pulse voltage from 5 volts until capture is lost Decreasing the pulse width from 2 msec until capture is lost

Decreasing the pulse voltage from 5 volts until capture is lost

The normal range for pacemaker lead impedance is _____ ohms. 15-30 50-100 100-500 300-1200

300-1200

While assisting with a pacemaker generator change on a pacemaker-dependent patient, the doctor attaches the new generator to the leads but no pacing occurs until the generator is placed in the pocket. This happened because: The leads are reversed in the header It is a unipolar configuration It is a bipolar configuration The pacing threshold is high

It is a unipolar configuration

Patients recently receiving internal cardiac defibrillators are instructed that they may drive a car after: They receive the lambs wool seat belt pad The first telephone pacemaker check They obtain their device identification card Their physician advises them

Their physician advises them

At the time of a dual pacemaker implant, the sensing threshold for the atrium must be at least which of the following? 0.5 mV 1.5 mV 5.0 mV 7.0 mV

1.5 mV

Current of injury (COI) is often experienced in an implantable cardioverter defibrillator (ICD) implant and attributed to which of the following? Atrial passive fixation Ventricular active fixation Anti-tachycardia pacing (ATP) Defibrillation threshold (DFT) Correct

ATP

What device polarity configuration uses the patient’s body to complete the pacemaker circuit? Unipolar Bipolar Biventricular Biphasic

Unipolar

After permanent pacemaker implant, a patient is evaluated by the device representative, registering the RV lead impedance at 100 Ω and 7.0mV. The RV lead reading suggests: Normal expected parameters for an acute lead RV lead insulation break RV lead wire fracture RV lead dislodgement

RV lead insulation break

During the insertion of a biventricular implant device, the right ventricular (RV) lead is commonly inserted prior to which of the following other leads? Right atrial (RA) lead Left ventricular (LV) lead Subcutaneous left ventricular (LV) lead Both B & C

Left ventricular (LV) lead

Placing a magnet over an implanted ICD device will result in which of the following? Enable to asynchronous VOO pacing Disable arrhythmia detection Suspend tachyarrhythmia therapies Both Disable arrhythmia detection and Suspend tachyarrhythmia therapies are correct

Both Disable arrhythmia detection and Suspend tachyarrhythmia therapies are correct

Which of the following conditions causes device lead dislodgment after device implant? Wedensky effect Pacemaker syndrome Chronaxie Twiddler’s syndrome

Twiddler’s syndrome

After the device implant pocket is ready for pocket closure, what is the correct closure order of layers to be sutured? Muscle, epidermis, dermis Muscle, subcutaneous, epidermis Subcutaneous, epidermis, dermis Subcutaneous, dermis, epidermis

Subcutaneous, dermis, epidermis

Ohm’s law is the relationship between___________. Threshold, resistance, and impedance Current, resistance, and impedance Current, voltage, and impedance Threshold, voltage, and resistance

Current, voltage, and impedance

Pacing thresholds are NOT influenced by_________. Lead maturation Use of a steroid tip lead Insulation break Insulation material

Insulation material

Which of the following may occur during the maturation period of a device lead? Tissue growth formulation of a fibrous capsule around the lead Acute threshold increase Inflammation All answers are correct

All answers are correct

ReTest Desk 1 Flashcards

(315 cards)