HRS Board Review 2025 New Courses (Reviewers Copy)-Implantable Devices - Evaluation, Management and Troubleshooting_Ellenbogen

Video Transcription

Video Summary

This lecture on Device Evaluation, Management, and Troubleshooting covers key aspects of device management in electrophysiology. It emphasizes the importance of understanding the nuances of guidelines for cardiac devices like ICDs and CRT and their application in various patient groups, including those with ventricular arrhythmias, hypertrophic cardiomyopathy, and other cardiomyopathies. The lecture highlights differences between the ESC guidelines and the 2018 ACC, AHA, and HRS guidelines, stressing the necessity of keeping up-to-date with these evolving standards.<br /><br />Special emphasis is placed on the distinctions in device indications based on the presence of certain cardiac conditions and arrhythmias, and the unique considerations for device therapy in these scenarios are outlined. Complex cases such as those involving unexplained syncope or specific arrhythmias underscore the tailored approach required for different patient subgroups.<br /><br />Furthermore, the session delves into the specifics of conduction system pacing, illustrating the differences between HIS bundle pacing and left bundle branch pacing, and the technical challenges associated with each. The lecture also addresses the management of device-related infections, highlighting the importance of complete system removal in cases of bacteremia and endocarditis to reduce mortality risk.<br /><br />The use of imaging for recognizing lead positions and potential complications, such as lead dislodgement, is reinforced. Finally, the lecture underscores troubleshooting techniques for device issues like oversensing, undersensing, inappropriate shocks, and programming strategies to minimize shocks and enhance device functionality. The session concludes with a review of CRT non-responders, stressing the need for optimal lead positioning, device programming, and patient-specific strategies to maximize therapeutic outcomes.

Keywords

Device Evaluation

Electrophysiology

Cardiac Devices

ICDs

CRT

Ventricular Arrhythmias

Cardiomyopathy

Conduction System Pacing

Device Infections

Lead Dislodgement

Troubleshooting Techniques