Session V: Clinical Scenarios/Device Management-6158-Workshop #8 Device Cases

Video Transcription

Video Summary

The workshop focuses on issues with device cases, radiology, electrocardiographic correlation, and troubleshooting. The first ECG tracing shows a patient with a CRT device who has not had any clinical improvement. The possible reasons for the patient being a non-responder are explored, including PVCs, lack of atrioventricular synchrony, failure to capture on the left ventricular lead, and the need for a left ventricular lead offset. The second ECG and chest X-ray demonstrate an arterial implant due to the right bundle branch block pattern and the central location of the lead in the chest X-ray. The third case involves a lead placed in the membranous septum, which is unlikely to cause compact AV node injury but can lead to high thresholds. The fourth case shows prominent valve in the coronary sinus, creating difficulty in placing a left ventricular lead. The last case involves an ECG pattern that indicates posterolateral vein pacing. Changing the output leads to anodal stimulation instead of the desired simultaneous pacing. The final case shows evidence of failure to capture, oversensing, and undersensing in a patient with a single-chamber pacemaker.

Keywords

device cases

radiology

electrocardiographic correlation

troubleshooting

CRT device