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To understand cardiac implantable electronic device (CIED) management, the clinician requires a foundation of information regarding CIED purpose, design and function, as well as experience in interpreting CIED output, i.e., electrical assessment of the system, programmed parameters, electrograms, and markers. In addition, one must be able to correlate and interpret the accompanying electrocardiographic tracing with the patient""s clinical presentation.

For students of CIED management, be they beginners in the field or more advanced, there is always an appreciation for case studies, i.e., real-world examples of managing a specific device-related issue.

To this end, this workbook of 61 device management case studies has been prepared by six talented RN Device Specialists and three physicians involved in the Heart Rhythm Service practice at the Mayo Clinic in Rochester, Minnesota. Included in the case studies are examples from pacemakers, ICDs and CRT devices, illustrating interpretation and management of a variety of device behaviors, some with abnormal function that requires diagnosis and management approach, and others that display appropriate behavior of a specific device algorithm that may be confusing for the CIED student.

~David L. Hayes, MD, and the contributors - adapted from the Preface.

- Perfect for exam prep, training across CIED devices, and as a reference to keep on hand in the lab.
- Real-world examples of managing a specific device-related issue.
- Includes straightforward clinical management issues to more complex issues that may be related to a specific device algorithm.

Case Studies
1. Variation in Paced QRS Morphology
2. Ventricular Undersensing in a Dual-Chamber Pacemaker
3. Atrial Pacing with a Competing Junctional Rhythm
4. Loss of AV Synchrony
5. Postventricular Atrial Refractory Period (PVARP) Function
6. Atrial Loss of Capture
7. Loss of Capture and Pseudofusion
8. Loss of RV and LV Capture
9. Atrial Undersensing
10. Functional Atrial Undersensing
11. Undersensing of Atrial Arrhythmia
12. Ventricular Safety Pacing
13. DDI Pacing Mode
14. Functional Ventricular Undersensing
15. Atrial Sensed Events in Refractory Period
16. Pseudo-Wenckebach Upper Rate Behavior (Medtronic)
17. Pseudo-Wenckebach Upper Rate Behavior (Boston Scientific)
18. Pseudo-Wenckebach Upper Rate Behavior (St. Jude Medical)
19. His Pacing Threshold at Implant
20. Crosstalk Oversensing on Ventricular Channel with His Pace/Sense Lead in RV Port
21. Pseudo Undersensing in Leadless Pacemaker
22. Remote Alert Follow-Up
23. Promoting Intrinsic Ventricular Conduction
24. Atrial Preference Pacing
25. Rate Drop Response
26. Rate Smoothing
27. Atrial Flutter Response
28. Atrial Tachyarrhythmia with Atrial Intervention Pacing
29. Mode Switch Termination with Failure to Establish AV Synchrony
30. Inappropriate Mode Switch
31. Loss of AV Synchrony Due to Inappropriate Mode Switch
32. Auto-PVARP and Inappropriate Mode Switch
33. Pacemaker-Mediated Tachycardia
34. Pacemaker-Mediated Tachycardia Intervention
35. Pacemaker-Mediated Tachycardia in CRT-P
36. Respiratory Trends and Atrial Oversensing
37. Signal Artifact Monitor
38. Ventricular Noise Reversion
39. Ventricular Oversensing with RV Lead Failure
40. Atrial Oversensing
41. Noise Oversensing
42. Electromagnetic Interference in ICD
43. RV Lead Failure
44. RV Lead Fracture
45. Atrial Oversensing with Inappropriate Mode Switch and Arrhythmia Induction
46. Short-Long-Short-Induced Ventricular Tachycardia
47. Managed Ventricular Pacing Mode and Ventricular Arrhythmias
48. Ventricular Pacing in the Vulnerable Period Due to Blanking and Associated Arrhythmia
49. Ventricular Pacing in the Vulnerable Period During Atrial Flutter
50. T-Wave Oversensing
51. RV Lead Integrity Warning and T-Wave Oversensing Discrimination
52. Subcutaneous ICD Oversensing
53. Mode Switch During VT Detection
54. Single-Chamber ICD with Atrial Sensing
55. Medtronic Detection Zones with Fast VT via VT versus Fast VT via VF
56. Ventricular Tachycardia Detection and Therapy
57. Ventricular Tachycardia Accelerating to Ventricular Fibrillation with Undersensing
58. Defibrillator Therapy Following Episode Termination
59. Effective CRT
60. CRT Pacing Diagnostics
61. CRT Pacing Diagnostics
Appendix A: Cases by Title
Appendix B: Cases by Manufacturer

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