ILR
What does ILR stand for
Implantable loop recorder
Pacing indications- How many can you name?
Bradycardia, heart block, tachy/brady, chronotropic incompetence, medication titration
True or False: Shocks are always painful
False. Not always, in VF and fast VT- patients faint prior to receiving the shock and may not remember or be aware of what just happened. (Shocks are usually 20-45 Joules and external shocks are up to 360)
What is CRT?
Cardiac resynchronization Therapy
A lead placed in the LV to synchronously pace with the RV and increase pumpability
What does the D stand for in CRT-D?
EP device RN roles.
MD clinic, RN clinic, Out of clinic, triage, remotes, APP clinic
How long does the battery last?
Old LINQ 3 yrs
New LINQII 4 yrs
what is Rate Response?
Used for patients that are Mobile. The device can sense physiologic activity and mimic a normal heart with higher heart rate- allows the HR to increase with activity
What does a magnet do to an ICD
It turns OFF tachy detection and does not affect the pacing. It blinds the defibrillator to any heart beat.
How do we know the CRT therapy has been effective?
Symptoms improve.
EF improves
6 min hall walk improves
What is ATP?
Anti tachycardia pacing.
pain free pacing therapy, fast pacing to interrupt the arrhythmia. Atrial or ventricular. Reduces shocks as much as 40%.
Is it MRI safe?
Yes. There is no reprogramming needed for an MRI.
What does a magnet do to the pacemaker?
It blinds the PPM to the pts natural heart rate and paces asynchronously at a predetermined rate.
St .Jude 100, BSX 100, MDT 85, BTK- depends on programming.
What happens to a defibrillator when it reaches the battery replacement time? RRT or ERI
It will still function x 3 more months
It will make a noise or vibrate.
Where is the LV lead placed
The LV lead is located in the coronary sinus as low and apical as possible-
That is why some patients develop phrenic nerve stimulation or diaphragmatic stimulation
Why is programing required during an MRI?
Paced at higher outputs to protect pacing if needed. It blinds ICDs to the artifact, so they do not get shocked in the MRI.
Some devices only require an MRI tech, some an RN, and some an APP or MD.
Not all hospitals will do device MRIs
Conditional vs non conditional
Cannot get MRI if abandoned leads
How do you get information?
It transmits through a remote device or phone app similar to the pacemakers.
What happens to the pacemaker when a patient dies.
When you are deceased, your ears cannot hear an alarm clock and a pacer is an alarm clock for your heart. It will not hear it if you pass away. It does not need to be removed unless cremation. It does not need to be turned OFF.
ICD indications?
Primary prevention- at risk of sudden cardiac death, cardiomyopathies and genetic (brugada syndrome, ARVD, HCM), EF < 35%- significant LV dysfunction or > 35% with unexplained syncope, long QT with risk factors for SCD
Secondary prevention- in response to evidence of deadly arrhythmia or inducible on an EP study
Sustained VT, NSVT with prior MI and EF < 40%, cardiac sarcoidosis
WHO CANNOT GET ONE? people with < 1 yr to live
How many leads in CRT?
Can be 2 or 3- does not need to have an atrial lead.
Can anyone check a device? How much training is needed?
Typically, a new device RN needs about 9 months of training. On the job training with some modules and training with the reps from the companies. There is also a national certification.
What are reasons to get an ILR
Cryptogenic stroke, Afib management, Arrhythmia management
What year was the first transvenous pacemaker implanted?
1958 in Sweden by Senning and Elmqvist
Can you get CPR with an ICD or an external shock?
Can a person providing CPR get a shock?
You can still get CPR with an ICD, and an external shock is not contraindicated. Make sure the pads are not on the device.
The person providing CPR would not feel the shock but may feel the person jump.
Who Qualifies for CRT?
Heart block pts who may develop pacer mediated cardiomyopathy.
QRS wider than 120
NICM
35% EF and NYHA II and III
(note that LBBB pacemaker may someday replace CRT)
What can't you do when you have a pacemaker? An ICD?
For both- Electrical arcs and sparks with in 12 inches- arc welding, faulty wiring. Stay away from strong magnets. Anything the device can pick up as a heart beat- things that deliver an impulse like a tens unit.