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

Video Transcription

Video Summary

This workshop covered various cases related to device interrogation and troubleshooting. In the first case, a patient with a history of syncope and a dual chamber transvenous ICD presented with low amplitude noise on the atrial and ventricular channels. The most likely explanation was over-sensing, possibly due to air bubbles in the header block or lead fracture. A chest X-ray was recommended to rule out a header block issue. In the second case, a patient with an ICD shock had an episode of ventricular tachycardia due to his primary prevention ICD detecting VT, and the therapy was appropriate. In the third case, a patient with non-ischemic cardiomyopathy had tachycardia noted on remote interrogation. Based on the available data, AV node reentry tachycardia was the most likely diagnosis. In the fourth case, a patient with a dual chamber pacemaker presented with dizziness and an ECG tracing showing retrograde atrial activation following a PVC. The most likely abnormality was RNRVAS or repetitive non-reentrant ventricular atrial synchrony. In the fifth case, a patient with an ICD presented with over-sensing of myopontentials on the RV tip-to-ring and tip-to-coil channels. This was likely due to pectoral muscle over-sensing. In the sixth case, a patient with complete heart block had a DDD pacemaker implanted with the RV lead placed in the membranous septum. The most likely abnormality associated with this lead placement was a high threshold due to insulation around the his bundle. In the seventh case, a patient underwent retrograde coronary sinus angiography, which revealed a prominent bicuspid valve. Finally, in the eighth case, a patient with a leadless pacemaker presented with dizziness. The most appropriate management was to extract the leadless pacemaker and implant a new one. Overall, these cases covered a range of device-related issues and highlighted the importance of proper diagnosis and troubleshooting techniques.

Keywords

device interrogation

troubleshooting

over-sensing

lead fracture

ventricular tachycardia

remote interrogation

AV node reentry tachycardia

RNRVAS

pectoral muscle over-sensing

complete heart block

leadless pacemaker