The Nuts and bolts of Paced ECG Interpretation

by Kenny, Tom

• ISBN13: 9781405184045
• ISBN10: 1405184043
• Edition: 1st
• Format: Paperback
• Copyright: 2009-04-20
• Publisher: Wiley-Blackwell

Summary

Nothing is more perplexing to the clinician new to device therapy than having to deal with cardiac electrocardiograms from a device patient. Pacemakers and other implantable cardiac rhythm management devices leave their "imprint" on ECGs and can significantly change what clinicians see - or expect to see. Evaluating paced ECGs can be challenging, yet nowhere is it taught in any sort of comprehensive manner.Designed specifically for clinicians new to device therapy, The Nuts and Bolts of Interpreting Paced ECGs and EGMs offers practical, reliable and objective information on paced cardiac electrograms. Written in a lively, intelligent and easy to navigate style, emphasizing real-life clinical practice and practical tips, this book includes illustrated paced ECGs by skilled artists to help minimize "fuzzy" lines and emphasize key points. Each chapter concludes with a checklist of key points from each subject ("Nuts and Bolts").

Author Biography

Tom Kenny
Vice President Clinical Education & Training
St. Jude Medical
Austin, TX, USA

Table of Contents

Preface	p. vii
Before We Start ...,	p. 1
Timing Cycles and Troubleshooting Review
Calculating Rates and Intervals	p. 5
Pacing Spikes	p. 8
The Basics of Capture and Sensing	p. 11
In Depth: Modes	p. 14
Ventricular Sensing	p. 17
Pacing Intervals	p. 19
Loss of Capture	p. 22
Oversensing	p. 24
In Depth: Sensing	p. 26
QRS Morphologies	p. 28
Fusion and Pseudofusion	p. 31
In Depth: Single-Chamber Timing Cycles	p. 34
Intermittent Oversensing	p. 36
Undersensing	p. 38
Hysteresis Intervals	p. 40
In Depth: Hysteresis	p. 42
Rate Response	p. 44
Annotated ECGs	p. 46
AV Synchrony	p. 49
Atrial Tracking	p. 51
AV Conduction	p. 53
States of Dual-Chamber Pacing	p. 55
Maximum Tracking Rate	p. 57
Pacemaker Multiblock	p. 60
Pacemaker Wenckebach	p. 63
Pacemaker-Mediated Tachycardia	p. 66
Mode Switching	p. 68
In Depth: Upper-Rate Behavior in Dual-Chamber Pacemakers	p. 71
Troubleshooting the Paced ECG	p. 73
More Troubleshooting the Paced ECG	p. 75
Automatic Capture Algorithms	p. 77
Capture Testing	p. 80
In Depth: Basic Troubleshooting Guide	p. 83
Navigating the Intracardiac Electrogram	p. 86
Tracings from a Programmer (Combining E-grams with the ECG)	p. 93
Stored Electrograms	p. 96
In Depth: Electrograms	p. 99
Conclusion	p. 101
Workbook
Introduction to Workbook	p. 105
Easy	p. 107
Moderate	p. 237
Tough	p. 313
Scramble	p. 409
Index	p. 475
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