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CC Jan 2016 Pacemakers

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echoecho's version from 2016-03-20 19:48

Section

Question Answer
How are permanent pacemakers classified?1) by the chamber that is paced 2) the chamber that is sensed 3) the pacemaker response to sensing 4) the presence or absence of rate modulation 5) whether or not multi-site pacing is present in any of the cardiac chambers
List the pacemaker nomenclature as description and codes of position I?1) chamber that is paced 2) O = none, A = atrium, V = ventricle, D = dual (atrium and ventricle)
List the pacemaker nomenclature as description and codes of position II?1) chamber that is sensed 2) O = none, A = atrium, V = ventricle, D = dual (atrium and ventricle)
List the pacemaker nomenclature as description and codes of position III?1) pacemaker response to sensing 2) O = none, T = triggered, I = inhibited, D = dual (triggered and inhibited)
List the pacemaker nomenclature as description and codes of position IV?1) presence or absence of rate modulation 2) O = none, R = rate modulation
List the pacemaker nomenclature as description and codes of position V? 1) presence or absence of multisite pacing 2) O = none, A = atrium, V = ventricle, D = dual (atrium and ventricle)
Position IV designation mayh be omitted if there is what?none
Position V is actually rarely used, true or false?true
Therefore, most pacemakers will have a ___ or ____ letter designation?3; 4
List the the indications for permanent pacemaker insertion as classified by the American Heart Assocation (AHA)?Class 1 (necessary); class II (may be necessary if potential benefit is present)/ class III (generally not indicated)
Regarding indications fro pacemaker insertion, under sinus node dysfunction and dysregulation, list the 3 classes with examples of each?Class I (symptomatic sinus bradycardia, recurrent syncope caused by ventricular asystole), class II (syncope associated with sinus node dysfunction, sinus node dysfunction where a link to clinically significant symptoms has not clearly been established), class III (asymptomatic sinus bradycardia)
Regarding the indications for pacemaker insertion, under AV condution abnormality, list the 3 classes with examples of each?Class I (3rd degree or advanced 2nd degree AV block), Class II (2nd degree AV block with loss of AV synchrony), Class III (asymptomatic 1st degree AV block)
Distinguish between a unipolar pacemaker and a bipolar pacemaker?1) unipolar (negative pole with the pacemaker device serving as the positive pole) 2) bipolar (with a distal negative electrode and a positive proximal electrode)
In general, which leads (unipolar or bipolar) are less susceptible to electromagnetic and electromechanical interference?bipolar
Leads may be fixed passively or actively, distinguish between the two?1) passively fixed (small tines from the lead become entrapped in the endocardial tissue by the growth of scar tissue over time) 2) actively fixed (using screws placed into the endocardium)
Right atrial leads are usually placed where? Right ventricular leads are usually placed where?1) right atrial leads are placed in the appendage 2) right ventricular leads are placed in the apex or septum
Chronotropically competent node use means what? Chronotropically incompetent node use means what?1) that patients are able to achieve an appropriate heart rate for a given level of exercise 2) patients who cannot achieve an appropriate heart rate for a given level of exercise
List the indications and contraindications for a pacemaker mode of VVI?1) indications: atrial fibrillation with symptomatic bradycardia in a chronotropially competent patient 2) contraindications: hemodynamic deterioration at the time of pacemaker insertion and patient with hemodynamic need for dual-chamber pacing
List the indications and contraindications for a pacemaker mode of VVIR? 1) indications: atrial fibrillation / flutter with symptomatic bradycardia in a chronotropically incompetent patient 2) contraindications: hemodynamic deterioriation at the time of pacemaker insertion and patient with hemdynamic need for dual-chamber pacing
List the indications and contraindications for a pacemaker mode of AAI?1) indications: symptomatic bradycardia as a result of sinus node dysfunction in a chronotropically competent patient with normal AV conduction 2) contraindications: sinus node dysfunction with associated AV block and when adequate atrial sensing cannot be obtained
List the indications and contraindications for a pacemaker mode of AAIR?1) indications: symptomatic bradycardia as a result of sinus dysfunction in a chronotropically incompetent patient with normal AV conduction 2) contraindications: sinus node dysfunction with associated AV block and when adequate atrial sensing cannot be obtained
List the indications and contraindications for a pacemaker mode of VVD?1) indications: congenital AV block, AV block when sinus node function is normal 2) contraindications: sinus node dysfunction, AV block with sinus node dysfunction, when adequate atrial sensing cannot be obtained and AV block with supraventricular tachycardia
List the indications and contraindications for a pacemaker mode of DDI?1) indications: need for dual chamber pacing wtih signficant paroxysmal supraventricular tachycardia in a chronotropically competent patient 2) contraindications: chronotropically incompetent patient with a demonstrated need or improvement with rate responsiveness
List the indications and contraindications for a pacemaker mode of DDIR?1) indications: AV block and sinus node dysfunction in chronotropically incompetent patient in the presence of significant paroxysmal supraventricular tachycardia 2) contraindication: none
List the indications and contraindications for a pacemaker mode of DDD? 1) indication: AV block and sinus node dysfunction in the chronotropically competent patient, need for AV synchrony and previous pacemaker syndrome 2) contraindication: chronic atrial fibrillation, atrial flutter, or frequent paroxysmal supraventricular tachycardia
List the indications and contraindications for a pacemaker mode of DDDR? 1) indication: AV block and sinus node dysfunction in the chronotropically incompetent patient 2) contraindications:
List the indications and contraindications for a pacemaker mode of AAIR / DDDR?1) indication: intermittent AV block and sinus node dysfunction in the chronotropically incompetent patient 2) contraindication: chronic atrial fibrillation, atrial flutter, or frequent paroxysmal supraventricular tachycardia
If a pacemaker stops working, list 4 considerations to consider as causes?1) interrogation of the device allows fro identification of many problems that cause malfunction 9circuit failure, battery depletion, over/undersensing of the device and "crosstalk" (electrical activity in one chamber is inappropriately sensed in a different chamber) 2) CXR may help to determine if a lead has migrated or become dislodged 3) electromagnetic interference can also produce dysfunction of a pacemaker (electrocautery, cardioversion, radiofrequency ablation, magnetic resonance imaging) 4) metabolic derangements can interfere with the proper pacemaker functioning (the most common is severe hyperkalemia) and hypomagnesemia also causes this, although less than hyperkalemia
*** In patients taking warfarin who need pacemaker placement, a recent study demonstrated that patients who continued warfarin had what?fewer complications than those who were bridged to heparin prior to device insertion
*** SUMMARY = Are asymptomatic sinus bradycardia and asymptomatic first degree AV block indications for pacemaker placement?no
*** SUMMARY = Are there indications for specific pacemaker nodes?yes
*** SUMMARY = What is the most common metabolic disturbance causing pacemaker malfunction?hyperkalemia
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