A Case-Based Approach to Pacemakers, ICDs, and Cardiac Resynchronization: Advanced Questions for Examination Review and Clinical Practice - Volume 2

Full Online Text Free with Purchase of a Print Book Many caregivers working in the field of medicine find that one of the best ways to learn is by working through clinical cases, and for many individuals it's even more helpful to work through the examples as "unknowns." This is especially true in the arena of implantable cardiac devices. In an effort to provide this experience, experts from the Mayo Clinic, Rochester, Minnesota, have produced two volumes of case studies that encompass variations of normal and abnormal function of pacemakers, ICDs, and CRT devices. The texts have been written collaboratively by five clinicians with differing backgrounds in an effort to present the cases in such a way that they are applicable to a variety of caregivers. Cases for this book were selected based on clinical relevance and their usefulness for illustrating general principles, practical tips, or interesting findings in device practice, with the goal of advancing general concepts in device management. The first volume includes introductory and intermediate cases. The second volume includes additional intermediate cases as well as advanced/multipart cases. Cover Page 1 Title Page 5 Copyright Page 6 Editors and Other Contributors 7 Preface 9 Abbreviations 11 Case 46 14 2. Repeat defibrillation threshold testing and consider lead revision 16 1. Lengthen the postsensing Decay Delay and increase the percentage threshold start 20 Case 47 22 3. Shock due to tachycardia rate greater than the SVT limit 24 Case 48 28 2. Shock due to morphology algorithm error 30 Case 49 34 3. Modified atrial-based timing 36 Case 50 40 2. AF inappropriately detected as ventricular tachycardia 42 Case 51 46 2. Atrial failure to capture is present 48 Case 52 52 3. Atrial noncapture 54 Case 53 56 4. Air in the header 60 Case 54 64 2. Reprogram the sensing pathway 66 Case 55 68 3. Ventricular lead fracture 70 1. Short circuit 76 Case 56 78 2. 91% 82 3. Increase beta blockade 84 Case 57 86 5. All of the above 88 2. B 90 4. Right atrium 92 4. Left ventricle 96 3. In the left ventricle 98 Case 58 100 5. All of the above 102 3. Atrial fibrillation 106 Case 59 112 4. Ventricular tachycardia/fibrillation leading to appropriate shock 114 3. The defibrillator lead is likely near the tricuspid annulus 118 2. Placing the active can in the abdomen 122 Case 60 124 2. Frequent PVCs 126 3. Atrial flutter 134 Case 61 136 4. May be eliminated or made less frequent by extending the PVARP 138 3. Ineffective biventricular pacing due to dyssynchronous AV pacing 142 3. Decreasing the paced AV interval 146 Case 62 148 2. Ventricular Rate Regulation (VRR) 150 4. Biventricular triggered pacing 154 4. Auto capture test with inappropriate detection of loss of capture 158 4. Programmed left or right ventricular lead offset 162 4. Elevated pacing thresholds with “failure to capture” 166 Case 63 168 1. When the vector of activation moves toward the positive pole of the ECG lead, an R wave is generated 170 4. The ECG is consistent with biventricular pacing with an LV lead placed in the posterolateral venous system 172 1. Middle cardiac vein 174 4. All of the above 176 4. There is evidence of biventricular pacing 184 5. All of the above 188 Case 64 190 2. AV node reentrant tachycardia 192 4. Frequent PVCs with triggering of polymorphic ventricular tachycardia is noted 198 4. All of the above 204 Case 65 206 3. Positive AV search hysteresis 208 3. Noncompetitive atrial pacing 216 2. Program off AV search hysteresis 224 Appendix 227 Index 229 Back Cover 234