Thread by @BirkhoelzerS

@TheBJCA Are you ready for 3rd @Medtronic Device Programming Course organised by @Nikhil_Ahl.
Summary of 2nd Course in the threat. @HRSonline #cardiotwitter #EPeeps
‼️‼️CHECK OUT: ppm.jph.am ‼️‼️
Check Chest X-ray, upload picture and identify PPM.

@Medtronic PBL STOP
P↔️Presenting Rhythm:
Look at surface ECG and Markers. Markers are "your friends" telling you what the device is seeing and how the device is responding.

@Medtronic PBL STOP
B↔️Battery status (Voltage & Impedance):
Check appropriate rate change due to magnet application in @Medtronic devices ✅85 bpm

@Medtronic PBL STOP
L ↔️Lead status (A & V + LV)
‼️check Impedance, ALERT if variation > 30% over time
‼️lead fracture ⬆️ Impedance
‼️Insolation issue ⬇️ Impedance
Expected range of impedance depends on lead (200-2000 ohms)

@Medtronic PBL STOP
S ↔️Sensing (intrinsic R-wave and p-wave)
‼️Oversensing leads to underpaying (possible asystole)
‼️Undersending leads to overpaying (symptoms?)
Appropriate values for sending in dual chamber pacemaker during implant p-wave > 2mV, R-wave > 5 mV

@Medtronic PBL STOP
T ↔️ Threshold testing (Stimulation Threshold=minimal electrical stimulus needed to consistently capture the heart outside of the heart's refractory period) < 1 V

@Medtronic PBL STOP
O↔️Arrhythmia observation
‼️Many pacemaker patients will develop atrial tachyarrhythmia over the life of their device
‼️Data on
- arrhythmia episodes
- rate drop response
- cardiac compass trends
- rate histograms
- counters

@Medtronic PBL STOP
P ↔️ Programming changes & printing
‼️All appropriate changes made?
‼️Any features that promote intrinsic conduction?
‼️Any changes required based on testing?

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