Workbook of Diagnostics for Cardiac Implantable Devices

David L. Hayes, MD
James D. Ryan, RN
Siva K. Mulpuru, MD
Nora E. Olson, RN
Tracy L. Webster, RN
Yong-Mei Cha, MD
Mark J. Henrich, RN
Jon M. Meyer, RN
Michael J. Hillestad, RN

Publication Details:
Publication Date: 3/2020
ISBN: 9781942909385
eISBN: 9781942909453
Trim Size: 8.5 x 11 inches
204 pages
Format: Paperback and eBook set; eBook

About:

To understand cardiac implantable electronic device (CIED) management, the clinician requires a foundation of information regarding CIED purpose, design and function, as well as experience in interpreting CIED output, i.e., electrical assessment of the system, programmed parameters, electrograms, and markers.  In addition, one must be able to correlate and interpret the accompanying electrocardiographic tracing with the patient’s clinical presentation.

For students of CIED management, be they beginners in the field or more advanced, there is always an appreciation for case studies, i.e., real-world examples of managing a specific device-related issue.

To this end, this workbook of 61 device management case studies has been prepared by six talented RN Device Specialists and three physicians involved in the Heart Rhythm Service practice at the Mayo Clinic in Rochester, Minnesota. Included in the case studies are examples from pacemakers, ICDs and CRT devices, illustrating interpretation and management of a variety of device behaviors, some with abnormal function that requires diagnosis and management approach, and others that display appropriate behavior of a specific device algorithm that may be confusing for the CIED student.

~David L. Hayes, MD, and the contributors – adapted from the Preface.

• Perfect for exam prep, training across CIED devices, and as a reference to keep on hand in the lab.

• Real-world examples of managing a specific device-related issue.

• Includes straightforward clinical management issues to more complex issues that may be related to a specific device algorithm.

Table of Contents:

Case Studies
1. Variation in Paced QRS Morphology
2. Ventricular Undersensing in a Dual-Chamber Pacemaker
3. Atrial Pacing with a Competing Junctional Rhythm
4. Loss of AV Synchrony
5. Postventricular Atrial Refractory Period (PVARP) Function
6. Atrial Loss of Capture
7. Loss of Capture and Pseudofusion
8. Loss of RV and LV Capture
9. Atrial Undersensing
10. Functional Atrial Undersensing
11. Undersensing of Atrial Arrhythmia
12. Ventricular Safety Pacing
13. DDI Pacing Mode
14. Functional Ventricular Undersensing
15. Atrial Sensed Events in Refractory Period
16. Pseudo-Wenckebach Upper Rate Behavior (Medtronic)
17. Pseudo-Wenckebach Upper Rate Behavior (Boston Scientific)
18. Pseudo-Wenckebach Upper Rate Behavior (St. Jude Medical*)
19. His Pacing Threshold at Implant
20. Crosstalk Oversensing on Ventricular Channel with His Pace/Sense Lead in RV Port
21. Pseudo Undersensing in Leadless Pacemaker
22. Remote Alert Follow-Up
23. Promoting Intrinsic Ventricular Conduction
24. Atrial Preference Pacing
25. Rate Drop Response
26. Rate Smoothing
27. Atrial Flutter Response
28. Atrial Tachyarrhythmia with Atrial Intervention Pacing
29. Mode Switch Termination with Failure to Establish AV Synchrony
30. Inappropriate Mode Switch
31. Loss of AV Synchrony Due to Inappropriate Mode Switch
32. Auto-PVARP and Inappropriate Mode Switch
33. Pacemaker-Mediated Tachycardia
34. Pacemaker-Mediated Tachycardia Intervention
35. Pacemaker-Mediated Tachycardia in CRT-P
36. Respiratory Trends and Atrial Oversensing
37. Signal Artifact Monitor
38. Ventricular Noise Reversion
39. Ventricular Oversensing with RV Lead Failure
40. Atrial Oversensing
41. Noise Oversensing
42. Electromagnetic Interference in ICD
43. RV Lead Failure
44. RV Lead Fracture
45. Atrial Oversensing with Inappropriate Mode Switch and Arrhythmia Induction
46. Short-Long-Short-Induced Ventricular Tachycardia
47. Managed Ventricular Pacing Mode and Ventricular Arrhythmias
48. Ventricular Pacing in the Vulnerable Period Due to Blanking and Associated Arrhythmia
49. Ventricular Pacing in the Vulnerable Period During Atrial Flutter
50. T-Wave Oversensing
51. RV Lead Integrity Warning and T-Wave Oversensing Discrimination
52. Subcutaneous ICD Oversensing
53. Mode Switch During VT Detection
54. Single-Chamber ICD with Atrial Sensing
55. Medtronic Detection Zones with Fast VT via VT versus Fast VT via VF
56. Ventricular Tachycardia Detection and Therapy
57. Ventricular Tachycardia Accelerating to Ventricular Fibrillation with Undersensing
58. Defibrillator Therapy Following Episode Termination
59. Effective CRT
60. CRT Pacing Diagnostics
61. CRT Pacing Diagnostics
Appendix A: Cases by Title
Appendix B: Cases by Manufacturer

* St. Jude Medical is now Abbott.

Appendix B - Cases by Manufacturer:

Biotronik Ilivia 7 HF-T QP 404620 CRT-D, CRT Pacing Diagnostics, Case 60
Biotronik Ilivia 7 HF-T QP ProMRI 404621 CRT-D, CRT Pacing Diagnostics, Case 61
Biotronik Lumax 740 VR-T DX SC ICD, Single-Chamber ICD with Atrial Sensing, Case 54
Boston Scientific Cognis 100-D N119 CRT-D, Pseudo-Wenckebach Upper Rate Behavior, Case 17
Boston Scientific Dynagen EL D150 SC ICD, Ventricular Tachycardia Detection and Therapy, Case 56
Boston Scientific Dynagen Mini D022 DC ICD, Defibrillator Therapy Following Episode Termination, Case 58
Boston Scientific Emblem A209 S-ICD, Subcutaneous ICD Oversensing, Case 52
Boston Scientific Energen DR E143 DC ICD, Ventricular Pacing in the Vulnerable Period Due to Blanking and Associated Arrhythmia, Case 48
Boston Scientific Energen E142 DC ICD, Ventricular Tachycardia Accelerating to Ventricular Fibrillation with Undersensing, Case 57
Boston Scientific Energen N141 CRT-D, Loss of AV Synchrony Due to Inappropriate Mode Switch, Case 31
Boston Scientific Essentio EL L121 DC PM, Pacemaker-Mediated Tachycardia Intervention, Case 34
Boston Scientific Essentio EL L121 DC PM, Rate Smoothing, Case 26
Boston Scientific Essentio L101 DC PM, Functional Atrial Undersensing, Case 10
Boston Scientific Essentio L101 DC PM, Loss of Capture and Pseudofusion, Case 7
Boston Scientific Essentio L101 DC PM, Mode Switch Termination with Failure to Establish AV Synchrony, Case 29
Boston Scientific Essentio L101 DC PM, Remote Alert Follow-Up, Case 22
Boston Scientific Essentio MRI EL L131 DC PM, Functional Ventricular Undersensing, Case 14
Boston Scientific Essentio MRI EL L131 DC PM, Signal Artifact Monitor, Case 37
Boston Scientific Essentio MRI L111 DC PM, DDI Pacing Mode, Case 13
Boston Scientific Incepta DR E163 DC ICD, Short-Long-Short-Induced Ventricular Tachycardia, Case 46
Boston Scientific Ingenio K173 DC PM, Atrial Flutter Response, Case 27
Boston Scientific Ingenio K173 DC PM, Atrial Undersensing, Case 9
Boston Scientific Inogen EL D141 SC ICD, Ventricular Oversensing with RV Lead Failure, Case 39
Boston Scientific Inogen X4 G148 CRT-D, Respiratory Trends and Atrial Oversensing, Case 36
Boston Scientific Inogen X4 G148 CRT-D, Ventricular Pacing in the Vulnerable Period During Atrial Flutter, Case 49
Boston Scientific Punctua N051 CRT-D, Atrial Oversensing, Case 40
Boston Scientific Valitude X4 U128 CRT-P, Pacemaker-Mediated Tachycardia in CRT-P, Case 35
Medtronic Adapta ADDR01 DC PM, Atrial Pacing with a Competing Junctional Rhythm, Case 3
Medtronic Advisa DR MRI A2DR01 DC PM, Atrial Oversensing with Inappropriate Mode Switch and Arrhythmia Induction, Case 45
Medtronic Advisa DR MRI A2DR01 DC PM, Atrial Tachyarrhythmia with Atrial Intervention Pacing, Case 28
Medtronic Advisa DR MRI A2DR01 DC PM, Crosstalk Oversensing on Ventricular Channel with His Pace/Sense Lead in RV Port, Case 20
Medtronic Advisa DR MRI A2DR01 DC PM, Rate Drop Response, Case 25
Medtronic Advisa DR MRI A2DR01 DC PM, Ventricular Undersensing in a Dual-Chamber Pacemaker, Case 2
Medtronic Azure XT DR MRI W1DR01 DC PM, Atrial Sensed Events in Refractory Period, Case 15
Medtronic Azure XT DR MRI W1DR01 DC PM, Auto-PVARP and Inappropriate Mode Switch, Case 32
Medtronic Azure XT DR MRI W1DR01 DC PM, His Pacing Threshold at Implant, Case 19
Medtronic Azure XT DR MRI W1DR01 DC PM, Postventricular Atrial Refractory Period (PVARP) Function, Case 5
Medtronic Claria MRI DTMA1D1 CRT-D, Medtronic Detection Zones with Fast VT via VT versus Fast VT via VF, Case 55
Medtronic Claria MRI Quad DTMA1Q1 CRT-D, Effective CRT, Case 59
Medtronic Claria MRI Quad DTMA1QQ CRT-D, Undersensing of Atrial Arrhythmia, Case 11
Medtronic Evera XT DR DDBB1D1 DC ICD, Atrial Preference Pacing, Case 24
Medtronic Evera XT DR DDBB1D1 DC ICD, Electromagnetic Interference in ICD, Case 42
Medtronic Evera XT DR DDBB1D1 DC ICD, RV Lead Fracture, Case 44
Medtronic Evera XT DR DDBB1D4 DC ICD, Loss of AV Synchrony, Case 4
Medtronic Evera XT DR DDBB1D4 DC ICD, Managed Ventricular Pacing Mode and Ventricular Arrhythmias, Case 47
Medtronic Evera XT DR DDMB1D4 DC ICD, RV Lead Integrity Warning and T-Wave Oversensing Discrimination, Case 51
Medtronic Micra VR TCP MC1VR01 SC PM, Pseudo Undersensing in Leadless Pacemaker, Case 21
Medtronic Percepta Quad W4TR01 CRT-P, Loss of RV and LV Capture, Case 8,
Medtronic Sensia SEDR01 DC PM, Pacemaker-Mediated Tachycardia, Case 33
Medtronic Viva Quad XT DTBA1Q1 CRT-D, Pseudo-Wenckebach Upper Rate Behavior, Case 16
Medtronic Viva XT DTBA1D1 CRT-D, Ventricular Safety Pacing, Case 12
St Jude Medical* Accent DR 2110 DC PM, Variation in Paced QRS Morphology, Case 1
St Jude Medical* Allure Quadra 3242 CRT-P, Pseudo-Wenckebach Upper Rate Behavior, Case 18
St Jude Medical* Anthem 3210 CRT-P, Noise Oversensing, Case 41
St Jude Medical* Assurity 2240 DC PM, Inappropriate Mode Switch, Case 30
St Jude Medical* Assurity DR 2240 DC PM, Atrial Loss of Capture, Case 6
St Jude Medical* Ellipse DR 2411-36Q DC ICD, Promoting Intrinsic Ventricular Conduction, Case 23
St Jude Medical* Fortify Assura VR 1357-40C SC ICD, RV Lead Failure, Case 43
St Jude Medical* Quadra Assura 3369-40Q CRT-D, Mode Switch During VT Detection, Case 53
St Jude Medical* Unify Assura 3357-40 CRT-D, Mode Switch During VT Detection, Case 53
St Jude Medical* Unify Assura 3357-40 CRT-D, Ventricular Noise Reversion, Case 38
St Jude Medical* Unify Assura 3357-40C CRT-D, T-Wave Oversensing, Case 50

*St. Jude Medical is now Abbott.