(FIT)-Module 5 Lectures: Clinical Scenarios and Device Management-Implantable Devices: Evaluation, Management, and Troubleshooting (Ellenbogen)

Video Transcription

Video Summary

This extensive lecture covers key aspects of device therapy related to pacemakers and implantable cardioverter-defibrillators (ICDs), focusing on evaluation, indications, management, and troubleshooting crucial for board examinations and clinical practice. It emphasizes understanding guideline-based device indications, including special patient groups such as hypertrophic cardiomyopathy, sarcoidosis, long QT syndrome, Brugada syndrome, neuromuscular diseases, and cardiac resynchronization therapy (CRT). The lecture highlights the importance of appropriate device selection and programming, including advances in cardiac physiologic pacing, conduction system pacing (His bundle and left bundle branch pacing), and subcutaneous ICDs. Troubleshooting device-related complications such as lead dislodgement, fractures, oversensing, undersensing, and inappropriate shocks is thoroughly discussed, with emphasis on interpreting electrograms, recognizing abnormal sensing (e.g., T-wave oversensing, lead noise, EMI), and programming strategies to reduce unnecessary shocks. Management principles of device infections and lead extractions are reviewed, detailing risk factors and diagnostic criteria. The lecture also addresses non-response to CRT, its causes, recognition on ECG, and optimization strategies. ICD-specific programming to maximize efficacy while minimizing inappropriate shocks is detailed, highlighting clinical trials and consensus guidelines. Complex arrhythmia discrimination using dual-chamber sensing, morphology algorithms, and pacing maneuvers for differentiating supraventricular from ventricular tachycardias are explained. Electrical storm management and proarrhythmia induced by pacing are covered. Finally, the lecture reviews perioperative device management, ethical considerations, and future directions, offering practical guidance and resources to solidify understanding and competency in device therapy and troubleshooting essential for clinicians and electrophysiologists.

Keywords

pacemakers

implantable cardioverter-defibrillators

device therapy

cardiac resynchronization therapy

hypertrophic cardiomyopathy

sarcoidosis

long QT syndrome

Brugada syndrome

neuromuscular diseases

conduction system pacing

His bundle pacing

left bundle branch pacing

subcutaneous ICDs

device troubleshooting

electrogram interpretation