Quizz - The 1st World Championship of device EGMs interpretation

P wave oversensing

VT

AF

P wave oversensing

EMI (electromagnetic interference)

VF/VT

AF

RV Lead Dislodgement

VF

RV Lead Dislodgement/ P wave oversensing

EMI (electromagnetic interference)

VF

Ventricular tachycardia

SVT

Dual tachycardia (sinus tachycardia + VT)

Sinus tachycardia

R-wave double counting

T-wave oversensing

Polymorphic VT

R-wave double counting

T-wave oversensing

This is a burst during the charge  

The burst is inefficient in reducing the VT

After the ATP the first ventricular signal (-) is undersensed

The programmed pacing mode is DDI

The programmed minimal pacing rate is 60 bpm

The maximal duration for an atrial pause is 1 second

Marker 1: Wenckebach behaviour and blocked P-wave

Marker 2: Wenckebach behavior and blocked P-waves

Intervention Rythmiq algorithm (Search AV +) and blocked P-waves

Biotronik: 8

Medtronic: 12

Sorin: 6

Appropriate Rythmiq commutation with second degree AV block

Ventricular undersensing

Far-field P-wave oversensing

LV pacing threshold: 2.5 V

Inefficient LV pacing

Right ventricular capture with the LV pacing lead

Atrial tachycardia

Ventricular tachycardia

Oversensing of the atrial activation with the RV lead

For the device, this is an episode of Ventricular Tachycardia

The diagnosis of VT 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

Cross-talk VA

T-wave oversensing

In Biotronik pacemakers, the duration of the post-atrial pacing ventricular safety window is 100 ms

There is a p wave oversensing

There is a R wave double counting

There is a VT

Pacing mode is DDDR

In Boston ICDs, there is a post A pacing ventricular safety window

In this tracing, V-Epsd (blue star) indicates that the VT detection window is satisfied (8/10)

The pacing mode is VDI during the duration

a VF episode is detected because V>A

The ICD begins the charge during the Quick Convert™ delivery

Secure Sense is triggered by 2 out of 3 fast ventricular events

The A pacing configuration is probably Unipolar

The ventricular safety window of 64ms can be extended

BV and VS intervals reset the VT counter

CRT is effective every 3 beats

Change from true bipolar to integrated bipolar sensing may solve the problem

Pacing mode is possibly DDI

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

There is a intermitent ventricular loss of capture

You propose to increase the A-tachy response (ATR) trigger rate

You propose to lower the value of the maximal V sensitivity

Pacing mode is VP-suppression

You propose to increase the atrial sensitivity (lower value)

ATP one shot is not delivered because the VF is unstable

The most likely diagnosis is a RV lead fracture

Return of sinus rhythm counter is programmed to 5 (nominal)

There is a rupture of the coil conductor

ODO 

AAI 75bpm

DDD 75 bpm

The ICD uses the combined counter to diagnose a VF episode (page 1)

First shock is not delivered because the device failed to reconfirm the arrhytmia after the end of the charge

The def shock is synchronized on a p wave