St. Jude Medical

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Case Studies. St. Jude Medical. Single Chamber ECG Analysis. ECG #1. Programmed Parameters Mode………………………………………….. VVI Base Rate……………………………………….. 70 ppm Magnet Response…………………….. Battery Test Hysteresis Rate………………………………… Off ppm. T Temporary programmed value. 1.0 Second. - PowerPoint PPT Presentation

Transcript of St. Jude Medical

Slide 1Answer ECG #2
Atrial Sensing Unknown
Dual Chamber ECG Analysis
Normal Atrial Sensing
Normal Ventricular Capture
Normal Ventricular Sensing
Answer ECG #4
Normal Ventricular Sensing
Answer ECG #5
Ventricular Sensing Unknown
Answer ECG #6
ECG‘s
Normal Atrial Capture with one beat showing functional loss of atrial capture
Atrial Undersensing
Normal Atrial Capture
Normal Atrial Sensing
Normal Ventricular Capture with two beats of functional loss of capture
Ventricular Undersensing
Normal Atrial Capture
Normal Atrial Sensing
Normal Ventricular Capture
Ventricular Sensing Unknown
Initiation of a Pacemaker Mediated Tachycardia (PMT) with following a PVC
Answer ECG #12
Loss of Atrial Capture initiating a Pacemaker Mediated Tachycardia (PMT)
Normal Atrial Sensing
Normal Ventricular Capture
Ventricular Sensing Unknown
Answer ECG #13
Normal Atrial Capture
Atrial Sensing Unknown
Normal Ventricular Capture
Normal Ventricular Sensing
The retrograde P-wave after the PVC is not seen because it falls in PVARP just like it should
Answer ECG #14
Twiddler‘s Syndrome
Twiddler‘s Syndrome
Operative Color Picture- Twiddler’s Syndrome
Courtesy of Dr. Ferdinand Venditti, Chief of Cardiology at the Lahey Clinic. Twiddler’s syndrome with lead twisted in the pocket. While the general advise is to never hold a lead with mechanical forceps or a hemostat as this may damage the lead, when the lead is as twisted as this one, it should not be re-advanced into the patient. Hence, it is being held with an instrument.
This lead has been subjected to excessive stresses such that even if straightened and re-advanced into the patient, it is likely to have mechanical problems at some later date. Hence, if the pocket has to be entered due to Twiddler’s Syndrome, the lead should be removed and replaced with a new lead.
Slide Series: X-Ray-99.ppt
Rib-Clavicle Crush - Dual Unipolar DDD pacing - X-Ray
These are cone down views of a PA chest x-ray obtained just prior to discharge after the pacing system was implanted and again 22 months later when the patient presented with an open circuit on the atrial channel. The measured lead impedance as > 1990 ohms. Both leads had been implanted via subclavian venipuncture using a relativiely medial approach. While one was totally transected, the other appeared to be functioning normally. However, as both leads were literally in the same tract and hence, both were subjected to similar external forces, both leads were replaced with the pulse generator moved to the other side of the body.
In this patient, a diligent search had been made for the cephalic vein at the original implantation. Only when it could not be found was the subclavian approach utilized. At the revision procedure, the patient did not have a detectable cephalic vein in the right antecubital fossae and there was only a thin whisp of a vein on venography. Hence, subclavian venipuncture was again utilized. This antedated the appreciation of accessing the axillary vein although in the revision procedure, attempts were made to stay as lateral as possible.
Slide Series: X-Ray-99.ppt
Rib-Clavicle Crush - Scanning EM of Internal insulation
The same lead shown in the X-ray and the gross picture of the extracted lead was dissected in the Reliability lab. The external conductor was carefully removed leaving the internal insulation and internal conductor coil. The insulation demonstrates abrupt breaks which expose the internal (proximal) conductor to the distal conductor. Make-break contact between these two conductors generated voltage transients leading to episodes of oversensing. Persistent contact may result in a total short circuit and noncapture despite the presence of an output. The measured impedance will be < 250 ohms.
Based on this scanning electron microscopic picture, the insulation is cracked through and through in multiple places from external stress on the lead. The insulation between these cracks is totally normal.
Slide Series: X-Ray-99.ppt
New lead placed via cephalic vein cutdown
Rib-Clavicle Crush
Provocative maneuvers
sleep >> wake
Flecainide
Bipolar VVI with 2nd degree Wenckebach exit-block due to hyperkalemia (serum K 7.3 mEq/L). Upon correction of elevated potassium level, capture threshold was 1.3 V @ 0.8 ms
Loss of Capture due to Intrinsic Rise in Capture Threshold
Folie *, V 1.1 /TK
First escape cycle followed by pacing at higher rate
Management
Education