(FIT)-Module 5 Workshop 9: Arrhythmia Case Studies (Putting It All Together for the Boards)-Ellenbogen Workshop 9

Ellenbogen Workshop 9

Pdf Summary

In Workshop #9, various case scenarios and their solutions are presented. Case 1 describes a 68-year-old male with shortness of breath and near syncope, presenting with an abnormal rhythm. The options for the rhythm include appropriate device function, loss of RV capture, intermittent loss of LV capture, and intermittent loss of RV and LV capture. The correct answer is intermittent loss of RV and LV capture. <br /><br />Case 2 involves a 68-year-old man with a biventricular ICD who has not seen improvement in heart failure symptoms. The correct answer, to improve LV pacing output, is explained by the need for LV pre-excitation and fusion. <br /><br />In Case 3, a 66-year-old male with a 1st generation SICD experiences shocking sensations while working in his wood shop. The patient's history and device interrogation results suggest the shock was due to atrial fibrillation with rapid ventricular response. <br /><br />Case 4 features a 25-year-old woman with symptoms of orthostatic lightheadedness, palpitations, and exercise intolerance. The tilt table test result shown is most consistent with postural orthostatic tachycardia syndrome (POTS). <br /><br />In Case 5, a 82-year-old male with a PM implanted for SSS returns for evaluation of his PM. The most appropriate next step is to proceed with aspiration of the pocket. <br /><br />Case 6 presents an ECG showing intermittent pre-excitation from a right-sided bypass tract. The correct answer is that no intervention is needed since the patient is asymptomatic. <br /><br />Case 7 involves a 56-year-old female with recurrent syncopal spells. The pause observed on the monitor is most likely due to phase 4 block in the His-Purkinje system. <br /><br />Case 8 features a 60-year-old woman with a cardiomyopathy. The most likely site for ablation would be dual AV nodal non-reentrant tachycardia (DAVNNT). <br /><br />Overall, these cases highlight different rhythm abnormalities and their appropriate management strategies.

Keywords

intermittent loss of RV and LV capture

biventricular ICD

LV pre-excitation and fusion

atrial fibrillation with rapid ventricular response

postural orthostatic tachycardia syndrome (POTS)

pacemaker pocket aspiration

right-sided bypass tract pre-excitation

phase 4 block in His-Purkinje system

dual AV nodal non-reentrant tachycardia (DAVNNT)

cardiomyopathy ablation