Cardiac Rhythm Device Management. PBL STOP Your acronym for a standardized follow-up

Transcription

1 Cardiac Rhythm Device Management PBL STOP Your acronym for a standardized follow-up

2 What s in it for you? What do you need to feel comfortable with a pacemaker/icd follow-up? 2

3 CORE OBJECTIVE Provide a technique for you to complete a successful device follow-up 3

4 PBL STOP P Presenting Rhythm and Rate B Battery Status L S Lead Status Sensing T Threshold O Observation, Data, and Events 4 P Program & Print

5 P Presenting Rhythm and Rate 5

6 Rhythm Recognition Atrial Fibrillation: No Pacing VVI / 60 Atrial Flutter: No Pacing DDDR / 60 6

7 Paced Rhythm Recognition Single Chamber Device: Ventricular Pacing Single Chamber Device: Atrial Pacing (AAI) 7

8 Paced Rhythm Recognition Sensing in the Atrium & Sensing in the Ventricle (AS-VS) Pacing in the Atrium & Sensing in the Ventricle (AP-VS) 8

9 Paced Rhythm Recognition Sensing in the Atrium & Pacing in the Ventricle (AS-VP) Pacing in the Atrium & Ventricle (AP-VP) 9

10 Troubleshooting VVI / 60 Loss of Capture 10

11 Troubleshooting Loss of Atrial Sensing 11

12 B Battery Status (Volts and Longevity) 12

13 Assessing Battery Status 13

14 Assessing Battery Status 14

15 L Lead Impedance (ohms) 15

16 Lead Impedance Trends 16

17 Assessing Lead Status 17

18 S Sensing (millivolts mv) The ability of the pacemaker to see Intrinsic Heart Beats 18

19 Normal Sensing Values Acute Phase (within 3 months of implant) P-waves = > 1.5mV R-waves = > 6mV Chronic Phase (>3 months post-implant) P-waves = > 1.0mV R-waves = > 5mV 19

20 Amplitude (mv) Sensitivity: Not Sensitive Enough As You Lower The Number, You Make The Pacemaker More Sensitive 5 mv mv 1mV 20 Time

21 Amplitude (mv) Sensitivity: Too Sensitive 5 mv 2 mv 1mV Time

22 Amplitude (mv) Sensitivity: Just Right 5 mv 2 mv 1mV Why is sensing so important? 22 Time

23 Oversensing vs. Undersensing Intrinsic beat not sensed Scheduled pace delivered Marker Channel shows intrinsic activity......though no activity is present 23

24 T Threshold The least amount of energy it takes to capture the heart 24

25 During Pacing, the Impulse: Travels via the myocardium, not the native cardiac conduction system, therefore, the QRS is wide Normal QRS Paced QRS 25

26 Capture 26

27 2 Settings Used to Ensure Capture GOAL Find the minimum amount of energy needed to consistently capture the heart (stimulation threshold). 1. Pulse amplitude the amount of voltage delivered to the heart by the pacemaker to ensure capture of the heart (strength of an output pulse) 2. Pulse width time (duration) of the pacing pulse 27

28 Amplitude Threshold Testing Keeping pulse width stable, decrement voltage until loss of 0.5ms 1.5V 1.0V.5V 28

29 O Observations, Data, and Events 29

30 Diagnostic Information 30

31 Cardiac Compass Up to 14 months of data Annotations to mark Programming (P), Interrogation (I) or Remote Interrogations ( _ ) Rhythm-control assessment with Treated VT/VF episodes per day and AT/AF total hours/day Rate-control assessment with V. Rate during AT/AF and V. Rate during VT/VF %Pacing/day to assess reduction of unnecessary right ventricular pacing Three HF Status Indicator Trends Average V. Day/Night heart rates Patient Activity HR variability 31

32 P Programming & Printing Final Reports 32

33 Programmed Parameters 33

34 Print Reports Print Final Reports Sensing test results Threshold test results Key observations Any changes this session noted on final report 34

35 PBL STOP P Presenting Rhythm and Rate B Battery Status L S Lead Status Sensing T Threshold O Observation, Data, and Events 35 P Program & Print