(FIT)-Module 5 Workshop 8: Device Cases-Ellenbogen Workshop 8

Ellenbogen Workshop 8

Pdf Summary

In this workshop, various cases related to cardiac device management were discussed. The first case involved a 68-year-old man with a single-chamber ICD who received a shock without any preceding symptoms. The most likely abnormality discovered in this case was oversensing of rapid make-break potentials. In the second case, the optimal device choice for a 68-year-old man with LBBB and a narrow QRS escape rate was discussed. The most appropriate device for this patient was a DDD pacemaker with an RV lead placed in the His/LBB region. In the third case, a patient with a DDDR pacemaker presented with repetitive non-reentrant ventriculo-atrial synchrony (RNRVAS) and AV search hysteresis. The best next step in this case was to reprogram the PVARP. The fourth case involved a patient with T-wave oversensing, which can be prevented by shortening the PVARP, shortening the AV delay, reducing the lower rate limit, or using specific algorithms. In the fifth case, a patient with an ICD on remote monitoring had a recording that showed noise on the electrogram between the SVC coil and pulse generator. The most likely result of this recording was pectoral muscle oversensing. The sixth case involved a patient with a leadless pacemaker who experienced an acute threshold rise with loss of capture, and the best next management was to extract the leadless pacemaker and implant a new one. The seventh case involved a patient with dilated cardiomyopathy who received two shocks while bending over, and the most likely cause was ICD lead perforation. Finally, the eighth case involved a patient who received an ICD shock, and the tracing demonstrated a ventricular tachycardia. Overall, the workshop provided insights into various cardiac device management scenarios and the appropriate steps to take based on the indications.

Keywords

cardiac device management

ICD shock

oversensing

DDD pacemaker

His bundle pacing

RNRVAS

PVARP reprogramming

T-wave oversensing

leadless pacemaker

ICD lead perforation