4.1 L) Cardiovascular Pacemakers

Front 1

List the Indications for a permanent

pacemaker (PPM).

Back 1

1. Complete Heart Block
2. Symptomatic Mobitz Type II Second degree Block
3. Sick Sinus Syndrome
4. Symptomatic bradycardias

( syncope / presyncope)
5. Hypersensitive Carotid artery syndrome
6. Type I Block with infra-HIS bundle block

Front 2

List the indications for an AICD.

Back 2

Patients at high risk of sudden cardiac death from ventricular arrhythmias
1. Documented episode of VF / sustained VT
2. Ventricular arrhythmia refractory to

standard antiarrhythmic therapy.
3. Electrophysiologically inducible ventricular

arrhythmia -drug resistant / drug intolerable / drug not available

Front 3

Contraindications to AICD ?

Back 3

1. Treatable ventricular arrhythmias -

responsive to medication
2. NYHA Class IV Heart Failure
3. Life expectancy < 6 months

Front 4

List the main pacemaker associated

arrhythmias. (5)

Back 4

1. Pacemaker mediated Tachycardia
2. Sensor-induced tachycardia
3. Runaway pacemaker
4. Pacemaker mediated Wenckebach AV Block
5. Lead dislodgment arrhythmia

Front 5

Which is incorrect regarding Pacemaker

arrhythmias?
A. Pacemaker-mediated tachycardia (PMT) is a re-entry tachycardia
B. Sensor-induced tachycardia can usually be terminated with the

application of a magnet
C. A CXR can confirm the diagnosis of lead displacement arrhythmia.
D. A Runaway pacemaker is more common in later model pacemakers.

Back 5

D. Runaway Pacemaker is more common in the Older generation pacemakers

Front 6

The application of a magnet to pacemakers, can resolve which 3 Pacemaker associated

arrhythmias?

Back 6

Magnet resolving arrhythmias

1. Pacemaker mediated Tachycardia (PMT)
2. Sensor-induced Tachycardia
3. Runaway Pacemaker

Front 7

List the 4 main pacemaker complication types.

Back 7

1. Failure to Pace - "malfunctioning"
2. Failure to depolarise "loss of capture"
3. Failure to sense "malsensing"
4. Oversensing.

Front 8

What are the main (4) causes of Failure to

pace - "Malfunctioning pacemaker" -

No pacemaker spike seen on ECG.

Back 8

1. Wire fracture
2. Lead displacement
3. Interference
4. Oversensing ** {Most common cause }

Front 9

What are the 3 main causes of Failure to Sense - "Malsensing" - Asynchronous pacing seen on ECG.

Back 9

1. Poor lead contact
2. New BBB
3. Programming problems

Front 10

What are the 4 main causes of a Failure to

capture - "Failure to depolarise"

- Pacing spikes seen on ECG, without capture waveform ( P / QRS waves )

Back 10

1. Electrode displacement
2. Wire fracture
3. Electrolyte disturbance ***
4. AMI

Front 11

What are the 3 main causes of "Oversensing" ?

Back 11

1. Large P/T waves
2. Skeletal muscle activity
3. Lead contact problems

Front 12

(Chan)
Which is incorrect regarding Pacemakers ?
A. Pacemakers have a 5 position code
B. Position I = Chamber sensed
C. Position III = Response to sensing
D. Chamber paced = Position I

Back 12

B.

Position I = chamber paced
Position II = chamber sensed

Front 13

(Chan)
What are the % Generic Pacemaker Codes?

Back 13

I = Chamber paced
II = Chamber sensed
III = Response to sensing
IV = Programmability / rate modulation
V = Anti-tachyarrhythmia functions

Front 14

(Chan)
Which of the following is incorrect ?
A. Dual pacing, sensing and atrial / ventricle inhibition = DDD
B. AAI = atrial pacing, sensing and inhibition.
C. AVI is used for those with chronically ineffective atria

( fibrillation / flutter)
D. Both the atria and ventricles are paced in DDD Pacing.

Back 14

C. V V I

Front 15

(Chan)
Which is incorrect regarding what the

ECG features are of a ventricular-paced rhythm (VPR) ?
A. There is usually a left axis deviation (LAD)
B. The QRS and T waves are concordant.
C. There are QS complexes in II , III and aVF.
D. There is usually poor R progression in the precordial leads.

Back 15

B. Discordant

Front 16

(Chan)
In regards to Pacemakers and Magnets, which of the following is incorrect?
A. Placing a magnet over a pacemaker eliminates Sensing.
B. Placing a magnet over a pacemaker initiates a synchronous mode of pacing.
C. The presence of a magnet induces either AOO, VOO or DOO.
D. It is useful for assessing pacemaker capture and treating Pacemaker-mediated tachycardia.

Back 16

B. It initiates an "Asynchronous " mode of

pacing.

Front 17

(Chan)
In regards to "Failure to Pace", which of the

following is incorrect?
A. Application of a magnet will yield no visible pacing spikes.
B. The most common cause is Lead fracture / dislodgment.
C. There is an absence of pacing where it is expected.
D. Battery or component failure can cause this.

Back 17

B. Most common cause is "Oversensing"

eg. Skeletal muscle myopotentials.

Front 18

(Chan)
In regards to Failure to Capture, which of the following is incorrect?
A. Application of a magnet yields no pacing spikes.
B. It may be intermittent.
C. The most common cause is "Exit Block" -electrode-myocardium

interface problems.
D. It may be atrial or ventricular.

Back 18

A. Application of a magnet shows regular

pacing spikes, but without 100% capture.

Front 19

(Chan)
List some causes of Failure to Capture.

Back 19

1. Exit Block
2. Lead fracture / dislodgement
3. Pacing voltage programmed too low
4. Low battery life
5. Elevated pacing thresholds
6. Electrolyte abnormalities - ** hyperK+
7. AMI
8. Metabolic derangements ( Acidaemia ; Hypoxia )