A Case-Based Approach to Pacemakers, ICDs, and Cardiac Resynchronization: Questions for Examination Review and Clinical Practice [Volume 1]
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A Case-Based Approach to Pacemakers, ICDs, and Cardiac Resynchronization: Questions for Examination Review and Clinical Practice [Volume 1]

Paul A. Friedman, Melissa A. Rott, Anita Wokhlu

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eBook - PDF

A Case-Based Approach to Pacemakers, ICDs, and Cardiac Resynchronization: Questions for Examination Review and Clinical Practice [Volume 1]

Paul A. Friedman, Melissa A. Rott, Anita Wokhlu

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About This Book

Many caregivers working in the field of medicine find that one of the best ways to learn is by working through clinical cases, and for many individuals it's even more helpful to work through the examples as "unknowns." This is especially true in the arena of implantable cardiac devices.In an effort to provide this experience, experts from the Mayo Clinic, Rochester, Minnesota, have produced two volumes of case studies that encompass variations of normal and abnormal function of pacemakers, ICDs, and CRT devices.The texts have been written collaboratively by five clinicians with differing backgrounds in an effort to present the cases in such a way that they are applicable to a variety of caregivers. Cases for this book were selected based on clinical relevance and their usefulness for illustrating general principles, practical tips, or interesting findings in device practice, with the goal of advancing general concepts in device management.The first volume includes introductory and intermediate cases. The second volume includes additional intermediate cases as well as advanced/multipart cases.

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Information

Year
2013
ISBN
9781935395461
Edition
1
Subtopic
Cardiology
2
PACEMAKERS
,
ICD
s
, 
AND
CARDIAC
,
RESYNCHRONIZATION
Case 
1
A 
67-year-old 
male 
received 
a 
dual-chamber 
ICD 
for 
inducible 
ventricular 
tachycardia 
in 
the 
presence 
of 
ischemic 
heart 
disease. 
Four 
years 
later 
he 
received 
his 
rst 
shock 
during 
a 
visit 
to 
his 
chiropractor. 
He 
had 
sought 
chiropractic 
treatment 
due 
to 
chronic 
shoulder 
discomfort.
Device 
settings:
•
Mode: 
DDD
•
Mode 
switch: 
on
•
Pacing 
rate: 
40 
bpm 
(lower 
rate), 
120 
bpm 
(upper 
rate)
•
Amplitude: 
2.6 
V 
(right 
ventricular), 
2.0 
V 
(atrial)
•
Pulse 
width: 
0.50 
ms 
(right 
ventricular), 
0.40 
ms 
(atrial)
•
Sensitivity: 
0.18 
mV 
(right 
ventricular), 
0.18 
mV 
(atrial)
•
Dynamic 
AV: 
off
•
Refractory 
after 
pace: 
250 
ms
•
Antitachycardia 
therapies: 
initial 
burst 
ATP 
followed 
by 
33-J 
shock
Upon 
interrogation 
the 
tracing 
in 
Figure 
1.1 
was 
obtained.
Friedman, 
Rott, 
Wokhlu, 
Asirvatham, 
Hayes
3
Q
:
1
As 
a 
result 
of 
the 
EGMs 
and 
therapies 
delivered, 
what 
would 
be 
your 
next 
step?
1. 
Initiate 
new 
or 
additional 
antiarrhythmic 
medications
2. 
Consider 
ablation 
of 
the 
ventricular 
ectopic 
focus
3. 
Reprogram 
ventricular 
sensitivity
4. 
Look 
for 
source 
of 
EMI
Figure 
1.1 
Tracing 
upon 
interrogation.

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