Pacing & Defibrillation

Unique and guided training + 800 clinical cases in the data bank

Quizz - The 1st World Championship of device EGMs interpretation

Primary tabs

Question

Your answer	Choice	Feedback	Correct answer
	P wave oversensing
	T wave oversensing
	VT
	RV lead fracture/insulation breach	GOOD ANSWER : RV lead fracture/insulation breach •Cloud of points on the tachogram. No train tracks. Atrial rate remains stable.
	AF

Question

Your answer	Choice	Feedback	Correct answer
	P wave oversensing
	T wave oversensing
	EMI (electromagnetic interference)
	Lead fracture
	VF/VT	GOOD ANSWER : VF/VT

Question

Your answer	Choice	Feedback	Correct answer
	AF
	T wave oversensing	GOOD ANSWER : T wave oversensing T-Wave Oversensing: “Train tracks” Why do the train tracks begin to separate? •Notice that, in general, the fast (bottom) part of the railroad tracks remains steadily at 300ms. •This represents a consistent interval between the R and T waves during the episode. T-Wave Oversensing: “Train tracks” •Medtronic interval plots are not completely linear. Notice each “notch” near the 0-axis represents 100ms, but toward the top of the graph each notch represents 300ms. •Therefore the atrial rate, which appears to be consistent at about 600ms, is actually slowing after each shock. The ventricular rate, therefore, slows as well.
	RV Lead Dislodgement
	Lead fracture
	VF

Question

Your answer	Choice	Feedback	Correct answer
	RV Lead Dislodgement/ P wave oversensing	GOOD ANSWER : RV Lead Dislodgement/ P wave oversensing •RV Lead Dislodgement: One month post device implant. Double counting. Double counting of P wave and R wave. Look at the interval between oversensed signals and most consistent with PR interval. Look at morphology of oversensed signal as well and most consistent with far field P wave.
	AF
	EMI (electromagnetic interference)
	Lead fracture
	VF

Question

Your answer	Choice	Feedback	Correct answer
	Ventricular tachycardia
	Dual tachycardia (VT+ SVT)
	SVT
	SVT + aberrant atrioventricular conduction	GOOD ANSWER : SVT + aberrant atrioventricular conduction RID - : morphology different from the reference; 3 possibilities: VT, dual tachycardia, SVT + aberrant conduction Afib: 2 possibilities: dual tachycardia, SVT + aberrant conduction Unstb: in favor of SVT + aberrant conduction
	Dual tachycardia (sinus tachycardia + VT)

Question

Your answer	Choice	Feedback	Correct answer
	Sinus tachycardia
	Slow VT	GOOD ANSWERS : Slow VT R-wave double counting Slow VT episode with AV dissociation. Very wide ventricular EGMs were double sensed. The second ventricular EGM was sensed after the post-sensed ventricular refractory period.
	R-wave double counting	GOOD ANSWERS : Slow VT R-wave double counting Slow VT episode with AV dissociation. Very wide ventricular EGMs were double sensed. The second ventricular EGM was sensed after the post-sensed ventricular refractory period.
	P-wave oversensing
	T-wave oversensing

Question

Your answer	Choice	Feedback	Correct answer
	Polymorphic VT
	Ventricular undersensing
	R-wave double counting
	P-wave oversensing
	T-wave oversensing	GOOD ANSWER : T-wave oversensing •T-wave oversensing •Oversensing of the T wave following a spontaneous ventricular event occurs preferentially in presence of a low-amplitude R wave. Sensitivity is are adjusted automatically, based on the amplitude of the R wave that was just sensed: when that amplitude is low, the likelihood is high of subsequently and rapidly reaching the highest sensitivity. Oversensing is facilitated by exercise, since exercise may be associated with a decrease in the R wave and an increase in T wave amplitude. The episode that was detected fell in the VT monitor zone, avoiding the delivery of any inappropriate therapy.

Question

Your answer	Choice	Feedback	Correct answer
	This is a burst during the charge	GOOD ANSWER : This is a burst during the charge Fast tachycardia detected in the VF zone; diagnosis of VF after 12 F cycles; burst during the charge + capacitors charge; termination of the arrhythmia; however, the number of VS was insufficient to fill the counter of sinus rhythm restoration (only 3 VS cycles instead of 5 needed: return to sinus programmed to 5); continuation of the capacitors charge; early recurrence of the arrhythmia; electrical shock at the end of charge; interruption of the arrhythmia and diagnosis of return to sinus rhythm.
	This is a burst before the charge
	The burst is inefficient in reducing the VT
	The parameter « return to sinus » is programmed to 3
	After the ATP the first ventricular signal (-) is undersensed

Question

Your answer	Choice	Feedback	Correct answer
	The programmed pacing mode is DDI
	The programmed minimal pacing rate is 45 bpm
	The programmed minimal pacing rate is 60 bpm	GOOD ANSWERS : The programmed minimal pacing rate is 60 bpm The maximal duration for an atrial pause is 1 second The programmed pacing mode is DDD with Rythmiq On (AAI with VVI backup pacing); the minimal programmed pacing rate is 60 bpm since VVI pacing is delivered at 45 bpm (15 bpm slower than the programmed minimal pacing rate); therefore the maximal duration of the ventricular pause is 1333 ms (45 bpm) and the maximal duration of the atrial pause is 1OOO ms (60 bpm)
	The maximal duration for a ventricular pause is 1.5 second
	The maximal duration for an atrial pause is 1 second	GOOD ANSWERS : The programmed minimal pacing rate is 60 bpm The maximal duration for an atrial pause is 1 second The programmed pacing mode is DDD with Rythmiq On (AAI with VVI backup pacing); the minimal programmed pacing rate is 60 bpm since VVI pacing is delivered at 45 bpm (15 bpm slower than the programmed minimal pacing rate); therefore the maximal duration of the ventricular pause is 1333 ms (45 bpm) and the maximal duration of the atrial pause is 1OOO ms (60 bpm)

Question

Your answer	Choice	Feedback	Correct answer
	Marker 1: Wenckebach behaviour and blocked P-wave
	Marker 1: inappropriate intervention of the anti-PMT algorithm and blocked P-wave	GOOD ANSWERS : Marker 1: inappropriate intervention of the anti-PMT algorithm and blocked P-wave Intervention Rythmiq algorithm (Search AV +) and blocked P-waves Marker 1: sinus tachycardia; after 16 consecutive cycles AS-VP-MT (spontaneous atrial activation and paced ventricle at the maximal tracking rate) with stable VP-AS interval, suspicion of PMT and prolongation of the PRAPV during one cycle explaining the cycle (AS) and the absence of ventricular pacing on one cycle Marker 2: sustained aspect of 2/1 corresponding to the intervention of the Rythmiq algorithm (search AV +); once the device has switched to DDD mode, prolongation of the AV delay during 8 consecutive cycles to search for a spontaneous ventricular activation; in this patient during exercise, the prolongation of the AV delay induces this aspect of 2/1 (1/2 atrial activation is in the PRAPV);
	Marker 2: Wenckebach behavior and blocked P-waves
	Marker 2:intervention of the anti-PMT algorithm and blocked P-waves
	Intervention Rythmiq algorithm (Search AV +) and blocked P-waves	GOOD ANSWERS : Marker 1: inappropriate intervention of the anti-PMT algorithm and blocked P-wave Intervention Rythmiq algorithm (Search AV +) and blocked P-waves Marker 1: sinus tachycardia; after 16 consecutive cycles AS-VP-MT (spontaneous atrial activation and paced ventricle at the maximal tracking rate) with stable VP-AS interval, suspicion of PMT and prolongation of the PRAPV during one cycle explaining the cycle (AS) and the absence of ventricular pacing on one cycle Marker 2: sustained aspect of 2/1 corresponding to the intervention of the Rythmiq algorithm (search AV +); once the device has switched to DDD mode, prolongation of the AV delay during 8 consecutive cycles to search for a spontaneous ventricular activation; in this patient during exercise, the prolongation of the AV delay induces this aspect of 2/1 (1/2 atrial activation is in the PRAPV);

Question

Your answer	Choice	Feedback	Correct answer
	Biotronik: 8	GOOD ANSWERS : Biotronik: 8 Boston Scientific: 16 SJM: 8 In Boston Scientific devices, the number of required consecutive VP-AS cycles is 16 For the other 4 companies, 8 consecutive VP-AS are required
	Boston Scientific: 16	GOOD ANSWERS : Biotronik: 8 Boston Scientific: 16 SJM: 8 In Boston Scientific devices, the number of required consecutive VP-AS cycles is 16 For the other 4 companies, 8 consecutive VP-AS are required
	Medtronic: 12
	SJM: 8	GOOD ANSWERS : Biotronik: 8 Boston Scientific: 16 SJM: 8 In Boston Scientific devices, the number of required consecutive VP-AS cycles is 16 For the other 4 companies, 8 consecutive VP-AS are required
	Sorin: 6

Question

Your answer	Choice	Feedback	Correct answer
	Appropriate Rythmiq commutation with second degree AV block
	Appropriate Rythmiq commutation with third degree AV block
	Ventricular undersensing	GOOD ANSWERS : Ventricular undersensing Inappropriate Rythmiq-commutation to DDD (no AV block) Inappropriate commutation to DDD-mode (no AV-block) induced by ventricular undersensing
	Inappropriate Rythmiq-commutation to DDD (no AV block)	GOOD ANSWERS : Ventricular undersensing Inappropriate Rythmiq-commutation to DDD (no AV block) Inappropriate commutation to DDD-mode (no AV-block) induced by ventricular undersensing
	Far-field P-wave oversensing

Question

Your answer	Choice	Feedback	Correct answer
	LV pacing threshold: 2.5 V
	LV pacing threshold: 2.75 V
	Inefficient LV pacing	GOOD ANSWERS : Inefficient LV pacing Atrial capture with the LV pacing lead Ineffective LV pacing; LV pacing captures the left atrium; atrial depolarization is sensed by the right atrial channel after a conduction delay between right and left atria; The LV lead had dislodged.
	Atrial capture with the LV pacing lead	GOOD ANSWERS : Inefficient LV pacing Atrial capture with the LV pacing lead Ineffective LV pacing; LV pacing captures the left atrium; atrial depolarization is sensed by the right atrial channel after a conduction delay between right and left atria; The LV lead had dislodged.
	Right ventricular capture with the LV pacing lead

Question

Your answer	Choice	Feedback	Correct answer
	Atrial tachycardia	GOOD ANSWERS : Atrial tachycardia Oversensing of the post BIV pacing signal with the atrial lead Oversensing of the atrial activation with the RV lead Atrial tachycardia and BiV stimulation. Paced ventricular events are sensed in the atrium (V/A cross-talk). A/V oversensing with sensing of the atrial signal by the ventricular channel and inhibition of BiV stimulation, resulting in a 2-3 seconds pause.
	Oversensing of the post BIV pacing signal with the atrial lead	GOOD ANSWERS : Atrial tachycardia Oversensing of the post BIV pacing signal with the atrial lead Oversensing of the atrial activation with the RV lead Atrial tachycardia and BiV stimulation. Paced ventricular events are sensed in the atrium (V/A cross-talk). A/V oversensing with sensing of the atrial signal by the ventricular channel and inhibition of BiV stimulation, resulting in a 2-3 seconds pause.
	Ventricular tachycardia
	Conducted atrial tachycardia
	Oversensing of the atrial activation with the RV lead	GOOD ANSWERS : Atrial tachycardia Oversensing of the post BIV pacing signal with the atrial lead Oversensing of the atrial activation with the RV lead Atrial tachycardia and BiV stimulation. Paced ventricular events are sensed in the atrium (V/A cross-talk). A/V oversensing with sensing of the atrial signal by the ventricular channel and inhibition of BiV stimulation, resulting in a 2-3 seconds pause.

Question

Your answer	Choice	Feedback	Correct answer
	For the device, this is an episode of Ventricular Tachycardia
	For the device, this is an episode of SVT	GOOD ANSWERS : For the device, this is an episode of SVT The discrimination of this episode is only based on the analysis of the onset parameter This is an episode of VT diagnosed SVT by the device based on single-lead discrimination: for the device the absence of onset is in favor of a sinus tachycardia.
	The diagnosis of VT is based on a discrimination based on the PR Logic
	The diagnosis of SVT is based on a discrimination based on the PR Logic
	The discrimination of this episode is only based on the analysis of the onset parameter	GOOD ANSWERS : For the device, this is an episode of SVT The discrimination of this episode is only based on the analysis of the onset parameter This is an episode of VT diagnosed SVT by the device based on single-lead discrimination: for the device the absence of onset is in favor of a sinus tachycardia.

Question

Your answer	Choice	Feedback	Correct answer
	Cross-talk VA
	Cross-talk AV	GOOD ANSWERS : Cross-talk AV T-wave oversensing In Biotronik pacemakers, the duration of the post-atrial pacing ventricular safety window is 100 ms In this tracing we observe post-VP and post-VS T wave oversensing and AV crosstalk with pacing at the end of the safety window (100 ms)
	T-wave oversensing	GOOD ANSWERS : Cross-talk AV T-wave oversensing In Biotronik pacemakers, the duration of the post-atrial pacing ventricular safety window is 100 ms In this tracing we observe post-VP and post-VS T wave oversensing and AV crosstalk with pacing at the end of the safety window (100 ms)
	In Biotronik pacemakers, the duration of the post-atrial pacing ventricular safety window is 110 ms
	In Biotronik pacemakers, the duration of the post-atrial pacing ventricular safety window is 100 ms	GOOD ANSWERS : Cross-talk AV T-wave oversensing In Biotronik pacemakers, the duration of the post-atrial pacing ventricular safety window is 100 ms In this tracing we observe post-VP and post-VS T wave oversensing and AV crosstalk with pacing at the end of the safety window (100 ms)

Question

Your answer	Choice	Feedback	Correct answer
	There is a p wave oversensing
	The atrial sensitivity is programmed (value) too high
	There is a R wave double counting	GOOD ANSWERS : There is a R wave double counting There is a VT •There is a double counting of the R wave during a VT episode (V>A) that must be corrected by increasing the RV post sense blanking. The classification is appropriated despite the double counting. •First and third A events are masked by the Far‑field protection after Vs.
	RV Blanking after atrial sensing must be increased
	There is a VT	GOOD ANSWERS : There is a R wave double counting There is a VT •There is a double counting of the R wave during a VT episode (V>A) that must be corrected by increasing the RV post sense blanking. The classification is appropriated despite the double counting. •First and third A events are masked by the Far‑field protection after Vs.

Question

Your answer	Choice	Feedback	Correct answer
	Pacing mode is DDDR	GOOD ANSWERS : Pacing mode is DDDR In this tracing, V-Epsd (blue star) indicates that the VT detection window is satisfied (8/10) •Pacing mode is DDDR (see AP-Sr marker indicating Atrial pacing at sensor rate) •The 7th marker As (red star) is sensed in the PVARP because of a Wenckebach behavior of device (spontaneous atrial rate too fast) •There is no post A pacing ventricular safety window (noise window instead) •V-Epsd indicates that the VT (not VF) detection window is satisfied (8/10)
	The 7th marker As (red star) is sensed in the PVARP, which has been extended to 500ms by the anti-PMT algorithm
	In Boston ICDs, there is a post A pacing ventricular safety window
	In this tracing, V-Epsd (blue star) indicates that the VF detection window is satisfied (8/10)
	In this tracing, V-Epsd (blue star) indicates that the VT detection window is satisfied (8/10)	GOOD ANSWERS : Pacing mode is DDDR In this tracing, V-Epsd (blue star) indicates that the VT detection window is satisfied (8/10) •Pacing mode is DDDR (see AP-Sr marker indicating Atrial pacing at sensor rate) •The 7th marker As (red star) is sensed in the PVARP because of a Wenckebach behavior of device (spontaneous atrial rate too fast) •There is no post A pacing ventricular safety window (noise window instead) •V-Epsd indicates that the VT (not VF) detection window is satisfied (8/10)

Question

Your answer	Choice	Feedback	Correct answer
	The pacing mode is VDI during the duration	GOOD ANSWERS : The pacing mode is VDI during the duration V-Dur indicates the end of the VT duration Quick Convert™ is engaged after V-Detect •The ICD switches to VDI after the V-Epsd marker (not programmable) •The end of VT duration (V-Dur marker) occurs before the end of the VF duration (V-Detect) •VF episodes do not require A/V rate analysis (V rate only) •Quick Convert™ is engaged after V-Detect and before charging (charge starts 300ms before the « Chrg » marker)
	V-Dur indicates the end of the VT duration	GOOD ANSWERS : The pacing mode is VDI during the duration V-Dur indicates the end of the VT duration Quick Convert™ is engaged after V-Detect •The ICD switches to VDI after the V-Epsd marker (not programmable) •The end of VT duration (V-Dur marker) occurs before the end of the VF duration (V-Detect) •VF episodes do not require A/V rate analysis (V rate only) •Quick Convert™ is engaged after V-Detect and before charging (charge starts 300ms before the « Chrg » marker)
	a VF episode is detected because V>A
	Quick Convert™ is engaged after V-Detect	GOOD ANSWERS : The pacing mode is VDI during the duration V-Dur indicates the end of the VT duration Quick Convert™ is engaged after V-Detect •The ICD switches to VDI after the V-Epsd marker (not programmable) •The end of VT duration (V-Dur marker) occurs before the end of the VF duration (V-Detect) •VF episodes do not require A/V rate analysis (V rate only) •Quick Convert™ is engaged after V-Detect and before charging (charge starts 300ms before the « Chrg » marker)
	The ICD begins the charge during the Quick Convert™ delivery

Question

Your answer	Choice	Feedback	Correct answer
	Secure Sense is triggered by 2 out of 3 fast ventricular events	GOOD ANSWER : Secure Sense is triggered by 2 out of 3 fast ventricular events •There is a crosstalk (sensing of the atrial output in the ventricular channel resulting in inhibition of the ventricular pulse) •Lead pacing/sensing configurations are always bipolar on ICDs •The ventricular safety window is indeed 64ms, but cannot be extended
	There is a T wave oversensing
	The A pacing configuration is probably Unipolar
	There is a ventricular bigeminy
	The ventricular safety window of 64ms can be extended

Question

Your answer	Choice	Feedback	Correct answer
	BV and VS intervals reset the VT counter	GOOD ANSWER : BV and VS intervals reset the VT counter Change from true bipolar to integrated bipolar sensing may solve the problem •The T-wave oversensing algorithm is applied after VT or VF has been detected to avoid inappropriate VT/VF therapy. It does not apply during consistent ventricular pacingCRT is effective every 2 beats •Increasing the decay delay may prevent this oversensing in St Jude Medical devices (not available in Medtronic ICDs) •Change from true bipolar to integrated bipolar sensing may solve the problem. The change from true bipolar to integrated bipolar sensing, permitted in new Medtronic devices, can sometimes lead to an increase of the R-wave amplitude and an increase in the ratio R/T wave amplitude that solve the problem.
	Turning on the T wave discrimination algorithm will eliminate this oversensing phenomenon
	CRT is effective every 3 beats
	To prevent this oversensing in this ICD, one can increase the decay delay
	Change from true bipolar to integrated bipolar sensing may solve the problem	GOOD ANSWER : BV and VS intervals reset the VT counter Change from true bipolar to integrated bipolar sensing may solve the problem •The T-wave oversensing algorithm is applied after VT or VF has been detected to avoid inappropriate VT/VF therapy. It does not apply during consistent ventricular pacingCRT is effective every 2 beats •Increasing the decay delay may prevent this oversensing in St Jude Medical devices (not available in Medtronic ICDs) •Change from true bipolar to integrated bipolar sensing may solve the problem. The change from true bipolar to integrated bipolar sensing, permitted in new Medtronic devices, can sometimes lead to an increase of the R-wave amplitude and an increase in the ratio R/T wave amplitude that solve the problem.

Question

Your answer	Choice	Feedback	Correct answer
	Pacing mode is possibly DDI
	The tracing is compatible with a normal functioning of the Saint Jude Medical Ventricular Intrinsic Preference (VIP™) algorithm
	If the device would have been a LivaNova pacemaker programed with AAISafeR ™: the pacing mode would probably have switched to DDD	GOOD ANSWERS : If the device would have been a LivaNova pacemaker programed with AAISafeR ™: the pacing mode would probably have switched to DDD The maximal Ventricular sensitivity is 2mV when programmed to “AUTO”, in this Biotronik PM •In DDI mode, each AP is followed by either a sensed or a paced V. There is a Ventricular undersensing. •The VIP doesn’t accept blocked Ap. It is a AVD hysteresis. •AAISafeR switch from ADI to DDD when 3 P waves are not followed by a sensed Ventricle in a 12 A intervals window •MVP from ADI to DDD when 2 P waves are not followed by a sensed Ventricle in a 4 A intervals window •The maximal Ventricular sensitivity is 2mV when programmed to “AUTO”, in this Biotronik PM
	If the device would have been a Medtronic pacemaker programed with MVP ™: the pacing mode would probably have switched to DDD
	The maximal Ventricular sensitivity is 2mV when programmed to “AUTO”, in this Biotronik PM	GOOD ANSWERS : If the device would have been a LivaNova pacemaker programed with AAISafeR ™: the pacing mode would probably have switched to DDD The maximal Ventricular sensitivity is 2mV when programmed to “AUTO”, in this Biotronik PM •In DDI mode, each AP is followed by either a sensed or a paced V. There is a Ventricular undersensing. •The VIP doesn’t accept blocked Ap. It is a AVD hysteresis. •AAISafeR switch from ADI to DDD when 3 P waves are not followed by a sensed Ventricle in a 12 A intervals window •MVP from ADI to DDD when 2 P waves are not followed by a sensed Ventricle in a 4 A intervals window •The maximal Ventricular sensitivity is 2mV when programmed to “AUTO”, in this Biotronik PM

Question

Your answer	Choice	Feedback	Correct answer
	There is a intermitent ventricular loss of capture
	You propose to increase the max tracking rate	GOOD ANSWERS : You propose to increase the max tracking rate You propose to increase the A-tachy response (ATR) trigger rate You propose to lower the value of the maximal V sensitivity •There is no loss of V capture. The last Vp beat (VP-FB) is not effective because delivered just after an undersensed intrinsic QRS. •The MTR should be increased to have a 1:1 tracking of the sinus tachycardia •The ATR trigger rate should be increased to avoid inapproriate fallback. •Entry count of ATR is 8 max. •There is a V undersensing which must be fixed by decreasing the value of the V sensitivity.
	You propose to increase the A-tachy response (ATR) trigger rate	GOOD ANSWERS : You propose to increase the max tracking rate You propose to increase the A-tachy response (ATR) trigger rate You propose to lower the value of the maximal V sensitivity •There is no loss of V capture. The last Vp beat (VP-FB) is not effective because delivered just after an undersensed intrinsic QRS. •The MTR should be increased to have a 1:1 tracking of the sinus tachycardia •The ATR trigger rate should be increased to avoid inapproriate fallback. •Entry count of ATR is 8 max. •There is a V undersensing which must be fixed by decreasing the value of the V sensitivity.
	You propose to increase the entry count of the ATR
	You propose to lower the value of the maximal V sensitivity	GOOD ANSWERS : You propose to increase the max tracking rate You propose to increase the A-tachy response (ATR) trigger rate You propose to lower the value of the maximal V sensitivity •There is no loss of V capture. The last Vp beat (VP-FB) is not effective because delivered just after an undersensed intrinsic QRS. •The MTR should be increased to have a 1:1 tracking of the sinus tachycardia •The ATR trigger rate should be increased to avoid inapproriate fallback. •Entry count of ATR is 8 max. •There is a V undersensing which must be fixed by decreasing the value of the V sensitivity.

Question

Your answer	Choice	Feedback	Correct answer
	Pacing mode is VP-suppression
	You propose to switch ON the Enhanced T-Wave Suppression algorithm
	You propose to increase the atrial sensitivity (lower value)
	The device has potentially self induced the arrhythmia	GOOD ANSWERS : The device has potentially self induced the arrhythmia ATP one shot is not delivered because the VF is unstable •Pacing mode is DDI. There is a R wave undersensing with a Vp on the T wave. Atrial signal are well detected unless in the PVAB. •The ryhthm in the VF zone must be regular (12%) for the ATP one shot to be delivered. Here stability is 51ms>12% of 251ms (30ms).
	ATP one shot is not delivered because the VF is unstable	GOOD ANSWERS : The device has potentially self induced the arrhythmia ATP one shot is not delivered because the VF is unstable •Pacing mode is DDI. There is a R wave undersensing with a Vp on the T wave. Atrial signal are well detected unless in the PVAB. •The ryhthm in the VF zone must be regular (12%) for the ATP one shot to be delivered. Here stability is 51ms>12% of 251ms (30ms).

Question

Your answer	Choice	Feedback	Correct answer
	The most likely diagnosis is a RV lead fracture
	DDI is the « episode » pacing mode	GOOD ANSWER : DDI is the « episode » pacing mode •Noise is present on 3 different channels which renders the diagnosis of lead fracture unlikely. This tracing is typical of electrocautery interference. The device switches from DDD to DDI after 3 fast intervals. Return to sinus is programmed to 3. ATP during charge is not delivered because the RR intervals are too short (<240ms). The discrimination channel is also contaminated, therefore the Secure Sense counter is reseted every 2 fast cycles.
	Return of sinus rhythm counter is programmed to 5 (nominal)
	ATP during charge is not delivered because the VF is unstable
	There is a rupture of the coil conductor

Question

Your answer	Choice	Feedback	Correct answer
	ODO
	AAI/VVI Rythmiq 75bpm
	AAI 75bpm	GOOD ANSWER : AAI 75bpm Atrial pacing without V synchronization. Rhytmiq would have triggered ventricular pacing at 1000ms interval (602/min).
	DDI 75 bpm
	DDD 75 bpm

Question

Your answer	Choice	Feedback	Correct answer
	The ICD uses the combined counter to diagnose a VF episode (page 1)
	The Fast VT zone is programmed via VF	GOOD ANSWERS : The Fast VT zone is programmed via VF First shock is not delivered because the device failed to reconfirm the arrhytmia after the end of the charge In this case after VF redetection, the shock is commited •The VF is classified using the FVT counter, not the combined counter. At the end of the FVT NID (=VF NID), the device reviews the last 8 V intervals, looking for FS intervals: if even one of the 8 is FS, the device classifies the episode as VF (if not, it classifies as FVT). •FVT is programmed via VF. See the « TF∙ »markers. When programmed via VT, the marker is « T∙F ». Morover, the first classification is FD, which would not be possible with a « FVT via VT » programmation. •After CE (charge end) the device is looking for two fast events out of five. There are 5 V intervals before « aborted »: two have to be shorter than the lowest VT zone + 60ms. Since the longest of these four is 520ms, then the lowest bound of the VT zone is <460ms. •On the Virtuoso platform, there is no confirmation of the shock after a first abort. •The shock is synchronized on a R wave.
	First shock is not delivered because the device failed to reconfirm the arrhytmia after the end of the charge	GOOD ANSWERS : The Fast VT zone is programmed via VF First shock is not delivered because the device failed to reconfirm the arrhytmia after the end of the charge In this case after VF redetection, the shock is commited •The VF is classified using the FVT counter, not the combined counter. At the end of the FVT NID (=VF NID), the device reviews the last 8 V intervals, looking for FS intervals: if even one of the 8 is FS, the device classifies the episode as VF (if not, it classifies as FVT). •FVT is programmed via VF. See the « TF∙ »markers. When programmed via VT, the marker is « T∙F ». Morover, the first classification is FD, which would not be possible with a « FVT via VT » programmation. •After CE (charge end) the device is looking for two fast events out of five. There are 5 V intervals before « aborted »: two have to be shorter than the lowest VT zone + 60ms. Since the longest of these four is 520ms, then the lowest bound of the VT zone is <460ms. •On the Virtuoso platform, there is no confirmation of the shock after a first abort. •The shock is synchronized on a R wave.
	In this case after VF redetection, the shock is commited	GOOD ANSWERS : The Fast VT zone is programmed via VF First shock is not delivered because the device failed to reconfirm the arrhytmia after the end of the charge In this case after VF redetection, the shock is commited •The VF is classified using the FVT counter, not the combined counter. At the end of the FVT NID (=VF NID), the device reviews the last 8 V intervals, looking for FS intervals: if even one of the 8 is FS, the device classifies the episode as VF (if not, it classifies as FVT). •FVT is programmed via VF. See the « TF∙ »markers. When programmed via VT, the marker is « T∙F ». Morover, the first classification is FD, which would not be possible with a « FVT via VT » programmation. •After CE (charge end) the device is looking for two fast events out of five. There are 5 V intervals before « aborted »: two have to be shorter than the lowest VT zone + 60ms. Since the longest of these four is 520ms, then the lowest bound of the VT zone is <460ms. •On the Virtuoso platform, there is no confirmation of the shock after a first abort. •The shock is synchronized on a R wave.
	The def shock is synchronized on a p wave