Implanted CRM Device System Radiography IBHRExam Prep www.pacericd.com
2 Where do they go?
3 Anatomy diagram
4 Anatomy
5 Pulse generator configurations www.pacericd.com
6 Guidant pacemaker pulse generator www.pacericd.com
7 Guidant ICD pulse generator www.pacericd.com
8 Guidant CRT-ICD pulse generator www.pacericd.com
9 Medtronic ICD pulse generator www.pacericd.com
10 St. Jude ICD pulse generator www.pacericd.com
11 Biotronik pacemaker pulse generator www.pacericd.com
12 Medtronic Reveal loop recorder www.pacericd.com
13 Implanted loop recorder www.pacericd.com
14 Single chamber pacing system www.pacericd.com
A 15 Dual chamber pacing system www.pacericd.com B
16 Dual chamber pacing system www.pacericd.com
17 Dual chamber pacing system www.pacericd.com
18 Single pass (VDD) lead www.pacericd.com
A 19 Lead introduction approaches www.pacericd.com B
20 Epimyocardial leads
21 Dual chamber epicardial pacemaker www.pacericd.com
22 CRT-P
23 CRT Reverse Remodeling www.pacericd.com
24 Early epicardial CRT-ICD
25 Active fixation leads
26 Pacemaker and ICD
27 Pacemaker and ICD
28 Two leads, one device? www.pacericd.com
A 29 ICD patches
30 Medtronic epicardial patches www.pacericd.com
31 Multiple leads and CPI patches www.pacericd.com
32 A closer look at the leads and patches www.pacericd.com
33 Lateral view of the leads and patches www.pacericd.com
34 Medtronic sub Q patch www.pacericd.com
35 Sub Q Array
36 Sub Q Array
A 37 A Coronary sinus lead www.pacericd.com B B
38 RVOT ICD lead placement www.pacericd.com
39 RVOT ICD lead placement www.pacericd.com
40 Rate / sense options www.pacericd.com
41 ICD SVC lead and RV lead
42 Lead migration? www.pacericd.com
43 Jugular vein lead implantation www.pacericd.com
44 Persistent left superior vena cava Persistent LSVC www.pacericd.com
45 Persistent left superior vena cava Persistent LSVC www.pacericd.com
46 Persistent left superior vena cava Patent RSVC and LSVC www.pacericd.com
Persistent left superior vena cava A AnteroPosterior P i view i w w w.p a Ri h A Right Anterior i Obli Oblique ce ric d. co m Persistent LSVC 47 L f A Left Anterior i Obli Oblique
48 Transmyocardial approach
49 Dextrocardia
50 Pneumothorax
51 Pneumothorax
52 Hemothorax
53 Problem?
54 Redundancy
55 Torsion
56 Lead dislodgment and perforation www.pacericd.com
57 Lead dislodgment and perforation www.pacericd.com
58 Problem?
59 Check two views www.pacericd.com
60 Across the PFO
61 RV loop
62 RV lead loop
A 63 Same patient Tip up Tip down B www.pacericd.com
A 64 Same patient Different days B www.pacericd.com
65 Before and after
66 System replacement Occluded right subclavian vein www.pacericd.com
67 New dual chamber pacing system www.pacericd.com
68 Subclavian crush www.pacericd.com
69 Subclavian crush
70 Subclavian kink
71 How many fractured leads?
72 Accufix Atrial Lead
w w w.p a ce ric d. co m Retractable leads? 73
74 Abdominal Twiddler
75 Twiddled to fracture
76 Twiddler
77 Lead Noise
78 Problem?
79 Problem?
80 Noise!
81 Intermittant failure to pace
82 Atrial lead fracture
83 Problem?
84 Problem?
85 Atrial intermittent failure to capture www.pacericd.com
86 Lead fracture below the first rib www.pacericd.com
87 Atrial lead out of position
88 Find two lead problems
89 Find two lead problems 1 2
90 Same patient, 7 days apart A B
91 Subclavian clavicle-first rib crush www.pacericd.com
92 Inner conductor fractures
93 Pseudofracture
94 Psuedofracture
95 Problem?
96 Strain loop pseudofracture
97 Endotak Pseudofracture
98 Endotak Pseudofracture
99 Where do they go?