CRM Final Review Exam 2022 With Complete Solutions.

Dr Jones calls and he has Mr. Faulkner in his office. Mr. Faulkner has an Assurity DR implanted. Dr. Jones wants to reprogram the sensor slope so the pacemaker will respond with a faster pacing rate, in response to Mr. Faulkner's activity level. Increase the slope setting ECG was taken from a patient with the pacemaker programmed to the following: DDD BR = 50PPM, AV Delay = 300ms MTR = 120 PPM, PVARP = 280ms. What is your interpretation? Ventricular Undersensing A 63 year old male was implanted four years ago with a DDD pacemaker for sinus node dysfunction. You are asked to look as the ECG. What do you think is going on? Intermittent loss of capture You receive a call from a clinician in regards to a patient with an Accent DR RF implanted. The clinician is viewing the stored electrograms and is seeing a high number of PMT Termination triggers. The stored EGMs show successful termination of the... 1. Test for retrograde conduction and extend the PVARP to a value longer than the retrograde conduction time T or F: When the sensor is programmed to Passive, the device will collect information from the sensor and plot it on the heart rate histogram in the form of yellow dots, to indicate rates at which the sensor would have paced that patient if it was turned on. True You are called to the telemetry unit to see a patient with a DC pacemaker. The telemetry tech tells you that the device is programmed to a BR of 60 ppm but shows you a strip of AS-VP at 65 PPM, you explain this is Appropriate DDD function with atrial tracking of sinus acceleration For the pre-AAE family of devices, at which rate does the RR AV delay feature begin to shorten the delays? 90 bpm Your best customer is on the phone, she would like to know the primary advantage of having a separately programmable AMS BR. It provides higher ventricular pacing rate during AMS to compensate for reduced atrial kick. A physician is on the phone and has a question about the AF Suppression algorithm. "Why can't we program Max AF Suppression Rate to 120 ppm?" Current device programming: DDDR SAV: 150ms BR: 60. Increase MSR to 120 ppm first in order to meet his AF Suppression goal Mr. Faulkner has an Accent DR with AF Suppression turned ON. He is currently atrial pacing at a rate of 80 ppm when a single P-wave occurs at a rate of 85 bpm within a 16-beat window. What will the new atrial pacing rate be for this patient? 80 bpm What AV delay will be used if crosstalk is detected within the crosstalk detection window and VSS is enabled. 120ms In the following tracing of a patient with an Accent DR device, why did the AV delay change from 203 to 289ms? VIP Activation Which of the following is NOT true about Negative AV Hysteresis? It will continue to subtract the delta off the AP-VS or AS-VS interval as long as the interval has not reached the programmed Shortest AV Delay You are asked to see a patent with an Assurity DR in the pacemaker clinic. The patient has developed PAF and is having frequent AMS episodes. You might suggest which of the following actions? Turn on AF Supression What is the best description of what VSS does when activated? Delivers a ventricular pace at an AV delay of 120 ms when crosstalk is sensed during the crosstalk detection widow Your Dr. calls you into his office and asks " what do Abbott pacemakers have for my patients with NCS or vasovagal syncope? Advanced Hysteresis with associated stored EGMs You are at lunch with Dr. Jones and he says "there is certainly more and more evidence that supports programming pacemakers to operate with minimal unnecessary RV pacing. I wish I did not have to program such long fixed AV delays. program standard AV delays and turn on VIP In the Assurity DR device, what is the name of the PMT Option used to terminate PMTs? This algorithm determines if the rhythm is sinus tachy or a PMT before taking any action. A pace on PMT T or F: Rest Rate mimics a normal heart's slower rates when at rest by decreasing the BR of the pacemaker to a lower rate when the patient is not active, as seen by the device sensor. True What criteria must be met for a device to exit AMS and return to DDD? FARI must be less (slower) than the MSR/MTR If a measured lead impedance was trending around 600 ohms and is not being measured as less than 150 ohms, what might that indicate? Insulation breach Your physician sees the 2:1 block rate displayed under the programmed parameters and cannot remember how to reprogram the 2:1 block rate. Which of the following actions could he take to make the 2:1 block rate higher? Turn on RR AV delay to high The settings below were based on a patient with complete heart block and a properly functioning SA node. Mode DDD BR: 60 MTR: 120, PAV: 200, SAV: 150, PVARP: 250. 150 bpm What is the pacemaker's definition of a PVC? A sensed ventricular event without a valid preceding atrial event PVC Options are features designed to help prevent? PMT's T or F: A Cap Confirm monitors the atrial threshold using a beat-beat algorithm just like Ventricular Auto Capture. False A Cap Confirm is compatible with which type of lead? Bipolar only T or F: When the Assurity DR device's A Cap Confirm algorithm runs its setup test before each threshold test, captured events will have a high Kendall Tau score, meaning that they match the stored template of a captured beat? False T or F: The Ventricular Auto Capture algorithm delivers a high output 'backup' pulse after every pacing stimulus to ensure patient safety. False In an Assurity device, when Lead Impedance Monitoring is programmed to 'monitor' what will the device do if the lead impedance measurement is out of range? Lead impedance is measured and diagnostics are recorded but the lead maintains the programmed polarity and an alert is displayed on the FastPath screen upon interrogation When will VIP deactivate? When consecutive V pacing has occurred at the maximum AV delay extension for the programmed number of search cycles Our patient's device is programmed to the following settings: Mode DDD BR: 60, MTR: 120, PAV: 200, SAV: 150, PVARP: 250, AMS: ON ATDR: 200. 121-150 bpm With lead impedance monitoring programmed to "polarity switch", if a lead impedance is 'out of range' the device will: Perform 4 additional measurements, if one of that 4 is out of range the device will perform an auto polarity switch Review the following programmer screen shot. Based on the ECG and EGM displayed, does this patient have AT/AF? Yes The following is an example of Pacemaker Wenckebach Which of the following Accents DR features can be most helpful in evaluating possible ventricular arrythmias? Programmable Hight V Rate SEGM duration and programmable pre-trigger T or F: The Assurity DR device provides daily alert monitoring via M for Continuous Time in AT/AF, Daily High V Rate in AT/AF, and Daily or Weekly AT/AF Burden. True In order to support the high speed RF and 64K telemetry as well as the large amount of data storage, Accent and AAE family of pacemakers features a new QMR battery. What is the chemical composition of the battery? Lithium anode and silver vanadium oxide and CFx cathode Which statement is true about ventricular sensed refractory period? The ventricular sensed refractory period begins when an intrinsic R wave is sensed and the sensed event is digitally rectified and measured T or F: Assurity DR devices offer fixed atrial sensitivity only, SenseAbility is not available for the atrium. False This arrhythmia can often exacerbate or worsen existing HF. It results in a loss of atrial kick, thus further reducing CO. AF With A Pace on PMT feature turned ON, at which point will the algorithm determine whether to treat the rhythm? After the Wiggle Test to check if there is any variability the VP-AS interval T or F: With the Assurity DR pacemaker, when you re-program RR PVARP from Low to High you are extending the atrial alert window to permit atrial tracking at a higher rate. True The Allure Quadra CRT-P has a total of how many pacing vectors? 14 vectors Reprogramming the Stability Delta from 40ms (nominal) to 100ms will cause the ICD: To be more likely to label an episode as a VT and give therapy Which of the following is NOT one of the feature improvements made to the AAE pacemakers? It ignores all atrial refractory intervals (AR-AR) during FARI calculation Please select the answer that best defines crosstalk: an atrial pacing that is sensed bu the ventricular lead which causes the ventricular channel to inappropriately inhibit RV pacing A patient with an Accent DR RF is initially programmed to the following settings: DDD BR: 60, MTR: 110, SAV: 200, PAV: 220, PVARP: 275, PBAV: 150. What will the new 2:1 Block point be? 138 bpm The IDE trial for Multipoint pacing was designed to be: A study to prove that Multipoint pacing is safe and equally effective when compared to traditional Bi-V pacing What is Abbott's recommendation regarding patient flow for Multipoint pacing? To activate MPP upon completion of the CRT gen change if the patient had not been a responder with the previous device, to wait at least 3 months post de novo implant in order to assess the patient's condition response to Bi-V pacing before determining whether to activate MPP Go over MPP and CRT devices and facts about them - A short 5ms 1v1 pacing delay is recommended to avoid potential functional loss of capture at the lv2 vector - Lv cap confirm is operational only on the lv1 vector - MPP devices can be programmed to pace between 2 widest anatomically spaced cathodes - Auto vect select in our MPP devices takes approx 1 minute to complete each vectors threshold At implant your patient is pacemaker dependent and is currently being paced through the Merlin PSA. You need to leave the PSA session to program the device that you interrogated at the beginning of the implant, but you cant lose the PSA. Do not end the PSA session but switch over to the device, the PSA will continue to provide pacing at the last programmed settings. Which of the following set of parameters are programmable options for overcoming t-wave oversensing? -Threshold Start -Decay Delay -Max Sensitivity -Low Frequency Attenuation Filter on T or F: ALL Abbott Medical ICD's and CRT-Ds rectify sensed signals and measure the signal amplitude from baseline to peak. True If the Threshold Start is programmed to 50% and the maximum measured R-wave is 9mV, at what sensitivity values will the algorithm start its decay? 3 mV Name this Fluoro view LAO In order for the device to continue to give VF therapy for a rhythm that re-detects a rate in the VT-1 zone, the Post VT/VF Detection Rate/Interval must be programmed to: Same as VT-1 Increasing the delta value for Sudden Onset will: decrease the likelihood of diagnosing the rhythm as VT T or F: If the ventricular morphology scores a high percent match on Far Field MD, then the complex is most likely VT. False If the SVT 'Diagnosis Criteria: is programmed to IF ANY then the following is true: IF ANY of the discriminators indicates VT therapy will be delivered T or F: The Far Field MD discriminator in Abbott ICDs collects a new template from a single R-wave complex every 3 hours. False If a device is programmed to deliver a 65% fixed tilt shock, the _____ of each phase of the biphasic waveform will vary based on system impedance. Pulse width Shown here is Lead I of an ECG taken during an RV Capture Threshold Test which was initiated at 2.75V. What is the issue observed in this ECG strip? LV lead in the RV port and T or F: Scanning is defined as an interval shortening between bursts or trains. True T or F: Ramp decreases the intervals between pulses within the burst of ATP. True Evaluate the EGM. What is the patient's rhythm AFTER the shock is delivered? VT In the RAO view, when the CPS SL II Outer catheter is seated in the CS os, the orientation of the gold marker rings will be? Open circles Which study looked at patients with a prior MI and low EF, did not require a + EP study and showed a 31% reduction in all cause mortality in the ICD group? MADITT II What is the definition of decay delay? The amount of time that the sensitivity level of the device remains at the threshold state value before beginning its decay When do Post Shock Pacing Output and Rate begin? Once the Post Shock Pause has ended During an implant of a new Durata lead you notice that the ventricular pacing leas impedance id greater than 2500 ohms, you suspect that: the ventricular pace sense set screw is loose in the device header