Pacemaker interogation
pace the atrium, sense nothing
An AOO pacemaker would pace and sense what (if any) chambers of the heart?
Right atrium and right ventricle
An AV universal pacemaker paces which chamber(s) of the heart?
inhibits inhibits
An example of an inhibited device is a VVI device: the pacemaker paces in the ventricle, and when it senses an event it the ventricle , it _________________ or withholds a pacing output. Most single- chamber devices in use are ____________________ devices.
Percentage pacing, Lead impedance, and Pacing outputs
Battery longevity can be affected by variables such as ___________________________, _________________________, and __________________________
hypertrophic cardiomyopathy
_________________________________ is when the ventricular walls thickens to the point that not only can it not contract properly, it cannot hold adequate quantity of blood for a heartbeat.
Ventricular
_________________________________ pacing is used in patient's who's atrial systems are not intact such as atrial fibrillation.
Chamber paced
The first letter of the pacemaker code tells the______________________.
pulse generator, leads, patient care system, and the patient
The four important interconnected elements of the pacemaker system are the _____________________, __________________, ______________________, and, ______________________
electrical output pulses
The function of the pulse generator is to generate ___________________________________________.
Failure to fire, Failure to sense, and Failure to capture
The most common pacemaker malfunctions include ______________________________________
Firing
The pacemaker's generation of an electrical impulse is called_______________________________
The battery pack.
The pulse generator is___________________________
PVARP :Post Ventricular Atrial Refractory Period
The purpose of ______________ is to prevent sensing any retrograde p-waves. If the retrograde p-waves are sensed, the device could initiate a Pacemaker Mediated Tachycardia (PMT). Any atrial beat falling into PVARP is noted as AR, which is not used to initiate an AV interval.
PVAB :Post Ventricular Atrial Blanking:
The purpose of ___________is to prevent sensing the ventricular beat in the atrium, which is termed crosstalk.
chamber sensed
The second letter of the pacemaker code refers to the ________.
Chamber sensed.
The second letter of the pacemaker code tells the________________________.
chamber or chambers
The second position in the NBG code describes the______________________________________ in which the device senses or detects signals.
response to sensed events
The third letter of the pacemaker code refers to the ________.
PAVI :Paced Atrial to paced Ventricular interval.
The__________________ is usually programmed 30 ms longer than the SAV to allow for conduction of the paced atrial beat to reach the left side of the heart.
pass through
Think of the sensitivity setting as a filter, when you set it high, you are allowing all signals up and including that height to ____________________________.
blocks out
Today's pacemakers have circuitry, which allows the right signals to pass through and which____________________ irrelevant or misleading signals.
Right ventricle
VVI pacemakers are inserted into what chamber of the heart?
The pacemaker fails to sense intrinsic beats and paces on top of them.
What describes undersensing?
VVI at 65
What is the default mode for medtronic devices once the device reaches RRT ?
They fire at their preset rate regardless of intrinsic beats, they can cause fibrillation if the paced beat lands on the vulnerable period of the intrinsic beat's cardiac cycle, they are the same as fixed rate pacemakers.
What is true about asynchronous pacemakers?
A spike
When a pacemaker fires, it creates what sign on the EKG?
A-V sequential pacing
When both the atrium and the ventricle are pacing, this is know as ________________________________
filter system
When clinicians program the sensitivity settings of a pacing system, they are adjusting the _____________________.
dilated cardiomyopathy
When the heart muscle gets flabby an enlarged: this is known as _________________________________
pass through
When you decrease the sensitivity setting, you are allowing only signals up to including that height to _________________________________.
Third degree AV block, Type II second degree AV block, Idioventricular rhythm
Which of the following rhythms WOULD BE an indication for a pacemaker?
Sinus rhythm
Which rhythm would NOT be an indication for a pacemaker?
AV block
While indications have expanded considerably, _______________________ remains one of the main indications for permanent pacing.
Sense the intrinsic P waves and deliver QRS complexes to follow those P waves within a preset rate range.
Your patient has his own P waves but no QRS complexes. His DDD pacemaker should
PMT :Pacemaker Mediated Tachycardia
__________ is a rapid AS-VP rate induced by the pacemaker due to retrograde p-waves being sensed and tracked by the IPG.
VA interval :Ventricular to Atrial interval
__________ is the time period measured from a ventricular beat to an atrial sensed or paced beat VB Ventricular
VB :Ventricular Blanking
____________ is a period of time during which the sense amplifiers are off and the pacemaker is "blind". This prevents the pacemaker from oversensing the VP or the ventricular depolarization after it has already been sensed.
LRI :Lower Rate interval
_____________ = AV + VA interval
Firing
_________________ refers to the pacemaker's generation of an electrical stimulus. It is noted on the EKG by the presence of a pacemaker spike.
Capture
_________________ refers to the presence of a P wave or QRS coplex (or both) after the pacemaker spike. This indicates that the tissue in the chamber being paced has depolarized. The pacemaker is then said to have "captured" that chamber. Paced QRS complexes are wide and bizarre and resemble PVCs
Sensing
_____________________ refers to the pacemaker's ability to recognize the patient's own intrinsic rhythm or beats in order to decide if it needs to fire. Most pacemakers function on a demand mode, meaning they fire only when needed (only on demand).
third degree
_______________________ is the most severe AV block and are class IIa indication, even when the patient has no symptoms.
Failure to fire
_______________________ is when the pacemaker fails to send out its electrical stimulus when it should. This can mean the pacemaker battery is dead or the connecting wires are interrupted. Or it can mean the pacemaker has oversensed something like extraneous muscle artifact and thinks its not supposed to fire. _____________________ is evidenced by lack of pacemaker spikes where they should have been. It usually results in a pause.
atrial
____________________________ pacing is used in patients is used for patients with sinus node dysfunction.
Pacing lead electrodes (sensing)
_____________________________ analyzes incoming information and responds appropriately deciding whether to deliver an output or not, based on what the person's heart is doing.
Permanent pacing
______________________________ may be considered necessary or appropriate for certain people with symptomatic bradyarrhythmia or, less commonly, to help prevent or terminate tachyarrhythmia.
Sinus node dysfunction
_______________________________ is the most common arrhythmic constellation that indicates pacing.
PAVB :Post Atrial Ventricular Blanking
: The purpose of__________________ is to prevent sensing the pacing output from the atrium in the ventricle, which is termed crosstalk.
Right atrium and right ventricle
A DDD pacemaker paces which chamber(s) of the heart?
Ventricle, sense nothing, and have no response to sensed events since it cannot sense.
A VOO pacemaker would pace the_____________________________________________________________
dual-chamber pacemaker
A _____________________________characteristically has two leads, one to the right atrium and one to the right ventricle, which can allow a heart rhythm that more naturally resembles the normal activities of the heart and reflects intrinsic depolarization.
fusion
A __________________________beat for a single chamber pacemaker is when there is a p wave before the singe chamber pacemaker takes over.
at its preset rate regardless of intrinsic beats.
A fixed rate pacemaker fires
1.8 V
A fresh lithium-iodine battery in a pacemaker is classified as having 2.8 V and is considered depleted at ______.
the wire inserted in the chamber that delivers the pacing stimulus
A pacing catheter is ________.
Through the skin
A transcutaneous pacemaker paces the heart
Blanking period (s)
A______________________________ is a period of time during which the sense amplifiers are off, and the pacemaker is blind. Some ___________________________are programmable, some are non-programmable.
voltage amplifier
A_______________________________ works by storing the electrical output until the right amount of energy is available and the releasing it.
Refractory Period (s)
A________________________________ is period of time during which sensed events are ignored for timing purposes, but included in diagnostic counters. Some __________________________are programmable, some are non-programmable.
triggered device
A________________________________ paces into a sensed event. While it is fairly uncommon to see VVT device in permanent use, many times clinicians will temporarily program triggered modes to evaluate device behavior.
> 30%
Abnormal impedance is _________ fluctuation from baseline measurments.
= or > 1.0 mv Pwave = or > 3.0 for R wave
Acceptable amplitude for P waves and R waves are _______ for P waves and ______ for R waves
intrinsic activity
All contemporary pacemakers sense the_________________________ and stimulate the heart only when the intrinsic heart rate falls below the programmed pacing rate.
P waves or QRS complexes following the pacemaker spikes.
Capture is evidenced on the EKG by the presence of________________________________________.
right side of the heart
Cardiac pacing and defibrillation leads for conventional pacemaker and implanted cardioverter defibillater (ICD) systems are implanted in the ___________________________ .
_______________require a pacing lead to be implanted in both the right and left sides of the heart.
Cardiac resynchronization therapy devices
position
Changing the patient's________________________ can help restore capture.
Sodium channel blockers
Class I___________________________ block sodium's influx into the cardiac cell, decreases myocardial excitability and contractility. Examples are 1a Quinidine, 1b lidocaine, 1c Flecainide. They treat SVT and VT liocaine (VT only 1b lidocaine)
the entire heart.
Conventional pacemakers and ICDs have found that pacing the right side of the heart sufficient to cause a contraction of __________________________.
the atrium and the ventricle in succession
DDD pacemakers pace
cardiac resynchronization therapy devices
Dilated cardiomyopathy and hypertrophic cardiomyopathy and types of heart failure that can be treated with __________________________________.
3 months
End of service is (EOS) is ______ months after RRT under normal device circumstances.
rate responsive capability
Essentially all contemporary pacemakers also incorporate a _____________________________ . This depends on a "sensor" incorporated into the pacemaker that can sense activity or respiratory rate and can alter the heart rate based on the perceived physiologic need.
insulation break, lead fracture, electrode placement, lead polarity, EMI
Factors that may affect sensing are :
Lack of a pacemaker spike where there should be one
If a pacemaker fails to fire, what is shown on the EKG?
insulation breach
If lead impedance decreases consider ____________________________
lead fracture or header connection
If lead impedance increases consider _________________________
Loss of capture
In ____________________ there is no P or QRS after the pacemaker spike. This is simply a matter of turning up the pacemaker's voltage so that it sends out more "juice" to tell the heart what to do. Maybe the signal it sent out was too weak to get a response from the chamber. Another possibility is that the pacing catheter has lost contact with the wall of the chamber it's in and cannot cause depolarization. ________________________ can also occur when the heart is too damaged to respond to the pacer's stimulus.
Sinus node dysfunction
________________________________ also called sick sinus syndrome or SSS describes sinus bradycardia, sinus arrest, sinoatrial block, paroxysmal superventricular, tachyarrhythmias which alternate with bradycardia spells and even asytole.
AV block
In the early days of pacing, _______________________________ was the most common conduction disorder for which a pacemaker was prescribed.
D
In the third position the letter ____ stands for dual, meaning the device may be triggered to pace by as sensed event in one chamber and inhibited by a sensed event in the other chamber.
3 hr, 7 days, 14 months
Lead impedance are measured every ________hrs and recorded every __________ days for ____________months
Managed Ventricular Pacing
MVP stands for ____________________________
2.8 V
Most pacemakers batteries have low voltages, usually around _________.
DDD
Mr. Gorp has a pacemaker that senses atrial and ventricular depolarizations and paces atrium and ventricle. It can be inhibited or triggered by sensed events. What kind of pacemaker is this?
Undersensing
Mrs. McShelton has a VVI pacemaker. She is having pacemaker spikes in the T waves, QRS complexes, and ST segments of her intrinsic beats. This is indicative of
200 to 2000 ohms
Normal pacing lead impedance is ______ to ______ ohms.
change the battery
One action that can correct failure to fire is to________________________________ .
reliable
One great benefit of the lithium-iodine over other sorts of powers sources is that it depletes over a predictable and ___________________________. It is not prone to sudden depletion or abrupt variations.
tachyarrhythmias
Overdrive suppression of_______________________________ is an indication for a pacemaker.
five to fifteen
Pacemaker batteries last____________ to__________ years, depending on their use.
Lithium-iodine
Pacemakers use a _____________________________ battery
MI
Patients with AV block and ________________________ may be indicated for permanent pacing.
Class I
Patients with cardiomyopathy, AV block or sick sinus syndrome are considered to have ___________ indications for pacemakers.
Chamber Paced: O=NONE A-ATRIUM V=VENTRICLE D=DUAL S= SINGE (A OR V)
Position I of the NBG code tells __________________________
Chambers (s) sensed: O=NONE A-ATRIUM V=VENTRICLE D=DUAL S= SINGE (A OR V)
Position II of the NBG code tells __________________________
Response to sensing: O=None T= Triggered I= Inhibited D- Dual
Position III of the NBG code tells __________________________
Rate modulation: O=None R=Rate modulation
Position IV of the NBG code tells __________________________
MULTISTLTE: O=NONE A-ATRIUM V=VENTRICLE D=DUAL (A + V)
Position V of the NBG code tells _____________________
Recommended replacement time
RRT stands for ___________________________________
EOS
Replace the battery immediately at _________
Sensed Atrial to paced Ventricular interval
SAV stands for ?
less sensitive, more sensitive
Setting the sensitivity settings higher makes the device _______________________________, while setting the sensitivity settings lower makes the device more sensitive.
voltage amplifier
Since pacemakers sometimes have to deliver output pules more than 2.8 V, they rely on a circuit called a __________________________ to multiply the voltage output.
pacemaker
Symptoms associated with loss of AV synchrony sometimes caused by a single camber pacing is known as _______________________________syndrome. It causes palpitations, lightheadedness and low blood pressure.
Battery status
The B in PBL-STOP stands for ____________________________
lead status
The L in PBL-STOP stands for _________________________
Presenting rhythm, rate and percentage pacing
The P in PBL-STOP stands for _______________________________
Sensing
The S in PBL STOP stands for ________________________
Threshold
The T in PBL STOP stands for ___________________________
Pacing threshold
The ____________________________ is the minimum electrical stimulus to consistently capture the heart outside the heart's own refractory period.
settings
The actual longevity of any device depends on how often it paces and at what________________________.
50%
The battery is the largest single element inside the device, taking up as much as __________ of the total guts.
pacing interval
The distance between consecutive pacemaker spikes is referred to as the ________.
chamber paced
The first letter of the pacemaker code refers to the ________.
Triple-chambered pacemakers
___________________________________typically have one lead in the right atrium, one to stimulate the right ventricle, and one to stimulate the left ventricle. These devices are used in patients who have weakened heart muscle (which results in heart failure). These pacemakers "resynchronize" the ventricles and may improve the efficiency of the contraction of the heart. They are also commonly referred to as "biventricular pacemakers."
Flexible insulated wires, or leads
________________________________carry electrical impulses from the generator to the heart muscle and relay information concerning the heart's natural activities back to the pacemaker. There may be several such wires, or leads, placed within the heart, most commonly in the right atrium and right ventricle; one type of pacemaker is "leadless" and does not have any wires.
Oversensing
______________________________is inappropriate inhibition of a demand pacemaker due to detection of signals other than R-waves, such as muscle artifact or T-waves.
Single-chamber
_____________________________pacemakers have one lead to carry impulses to and from either the right atrium or right ventricle.
Undersensing
___________________________occurs when the pacemaker does not sense intrinsic cardiac activity that is present and delivers a pace pulse when it shouldn't.
pacing leads
________________________most commonly incorporates one or two electrical "poles causes an electrical impulse is transmitted to the heart muscle when needed, and the lead is also able to sense the heart's intrinsic electrical activity.
VRP :Ventricular Refractory Period
____________is a period of time when sensed events are ignored for timing purposes, but included in diagnostic counters. This prevents falsely sensing R-waves and T-waves.
AB :Atrial Blanking
____________is the period of time when the atrial sense amplifier is not sensing. This prevents the pacemaker from oversensing an atrial pacing stimulus or the depolarizing atrium.
TARP :Toal Atrial Refractory Period
___________is defined as the SAV+PVARP. No atrial beats can be tracked within this interval. If an atrial beat falls into this interval, it is labeled as an AR. When the atrial rate reaches TARP rate, the pacemaker exhibits a 2:1 block behavior.
pulse generator (A thin metal box or case)
contains the power source producing the electrical impulses of the pacemaker. In addition, the pulse generator contains a small computer processor that can be programmed to set the rate of the pacemaker, the pattern of pacing, the energy output, and various other parameters. The pulse generator for most modern permanent pacemakers weighs one to two ounces.
artificial pacemaker
is a medical device that generates electrical impulses delivered by electrodes to contract the heart muscles and regulate the electrical conduction system of the heart.
Pacemakers
may be single, dual, or triple chambered:
An artificial pacemaker
pacemaker provides an electrical impulse (or "discharge") that can stimulate the heart, thus restoring or maintaining a regular heartbeat.
