EP Lab Digest - December 2007 - (Page 29)

DECEMBER 2007 PACEMAKER PUZZLE 29 Pacemaker/ICD Puzzle Melanie T. Gura, RN, MSN, CNS, CCDS/AP FHRS, FAHA , Director, Pacemaker & Arrhythmia Services Northeast Ohio Cardiovascular Specialists Akron, Ohio Email Discussion Group: December 2007 Compiled by Jodie Elrod I n this new feature, see if you can figure out what is being demonstrated in the Holter recording. t’s been a busy year for our discussion group, and although we are nearing the end of 2007, the discussion group is still bustling with questions. If you would like to join in on the discussion, please email us at eplabdigest@hotmail.com or visit us at www.eplabdigest.com (click on the email discussion group link). Remember, when posting or responding to the discussion group, please let us know if you would like your name, location, and/or email address listed as well. I We look forward to hearing from you! New Questions: EP Lab Work Schedule Our EP lab will be going to 8hour shifts, 5 days a week in a couple of months. This is a decision that is widely unpopular with our nurses and techs. I am wondering if any other EP labs work 8-hour shifts (all 73:30) 5 days a week, and if so, what has been your experience with this scheduling format? Any pros, cons, suggestions? — Lee Henry, RN (To reply to this question, please type “Work Schedule” in your subject line.) DFT Testing in Patients with Low Ejection Fractions (EF) Less than 10-15% Shaking the bushes to see if anyone has any anecdotal data regarding defibrillation threshold testing during implant in patients with a low EF% of 10 or less: initial shock, second shock, third shock, rescuelimiting inductions and testing to one course or multiple courses. Single initial shock with number of joules 10 less than defib max. — Dana St. John, RN (To reply to this question, please type “DFT Testing” in your subject line.) Pocket Closure I am a registered nurse in a fairly new EP lab. The only procedures we currently do are EP studies and AICD/Bi-V AICDs. We have one electrophysiologist on staff. He requested that myself, an RN, and another staff member (an RCIS) learn how to close the pocket. He personally taught each of us how to suture the pocket closed. After approximately 10 months, hospital administration told us we were no longer allowed to perform this task, so we quit. Now, two months later, the RN is being formally reprimanded for working out of her “scope” of practice. Do rules about this vary from state to state, institution to institution, or is it just plain wrong for anyone besides the MD to close the pocket? — anonymous (To reply to this question, please type “Pocket Closure” in your subject line.) EP Training I have taken a job in the cath lab. I am an RT, wishing to obtain EP training. Could you please tell me where I could go to get effective training without being away from my children for months? Thanks! — Cyndi, Ft. Smith, Arkansas (To reply to this question, please type “EP Training” in your subject line.) Figure 1. Clinical History A 56-year-old female with nonischemic dilated cardiomyopathy, an ejection fraction of 25%, congestive heart failure, recurrent atrial fibrillation, pulmonary hypertension, and hyperlipidemia, states that she has periodic palpitations associated with shortness of breath. She denies chest pain, orthopnea, dizziness, and syncope. • No ventricular tachyarrhythmias • No atrial fibrillation • No change in atrial and ventricular stimulation and sensing thresholds • 24-hour Holter revealed this ECG (See Figure 1) Pacemaker/ICD Puzzle Question: Which of the following is demonstated in the Holter recording shown in Figure 1? A: Ventricular oversensing B: Loss of ventricular capture C: Concealed conduction D: Crosstalk inhibition E: Normal device function Device History S/P ICD implantation: • ICD: Medtronic D154ATG EnTrust™ • A Lead: Medtronic 5076 CapSure Fix Novus • V Lead: Medtronic 6949 Sprint Fidelis Medications • Coreg: 6.25 mg bid • Digoxin: 0.25 mg qd • Lasix: 80 mg bid • Lisinopril: 10 mg qd • Spironolactone: 25 mg, 1/2 tab qd • Warfarin (as directed) • Lipitor: 20 mg qd • Zyrtec: 10 mg qd Readers, email your guesses to “jelrod@hmpcommunications.com”. The correct answer will be revealed in next month’s issue! Under Discussion: ACT Guidelines I was just wondering what people are using for ACT guidelines during pulmonary vein isolations. I am also curious as to what ACT machine they are using. — Heidi Helmer, RN, BSN (To reply to this question, please type “ACT Guidelines” in your subject line.) See EMAIL DISCUSSION GROUP page 30 Physical Examination On examination, there was no JVD, chest sounds were clear to auscultation, heart sounds were regular with a normal S1, S2 without rubs, murmurs or gallops, and no edema. Device evaluation revealed normal ICD function: Readers, let us know if you have a pacemaker or ICD puzzle that you would like to see featured in this section. Email all submissions to: “jelrod@ hmpcommunications.com” http://www.eplabdigest.com

Table of Contents Feed for the Digital Edition of EP Lab Digest - December 2007

EP Lab Digest - December 2007 Improved Anatomical Orientation During AF Catheter Ablation: Experience from Leipzig Heart Center One EP Lab’s Solution to the Administration of Deep Sedation Contents Letter from the Editor Spotlight Interview: Northeast Georgia Medical Center Emerging Technologies for the Electrophysiology Lab The Western Atrial Fibrillation Symposium About the PRECEDE-HF Trial: Interview with William T. Abraham, MD, FACP, FACC, FAHA Overview on Shire and the Discontinuation of Ethmozine®: After the Heart Rhythm Society Intervenes, the Company Changes its Decision Minimizing the Risk of Infection at Children’s Sibley Heart Center: Interview with Nicole Jarrell, RNC, MSN, and J. Renee Watson, RN, CIC Is There a Link Between Gasoline Vapors and Brugada Syndrome? Interview with Darko Kranjcec, MD and Hugues Abriel, MD, PhD New Feature! Pacemaker/ICD Puzzle Email Discussion Group Events Calendar Industry News and Products

EP Lab Digest - December 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.