AF Equipment Operation & Maintenance 2 — Questions and Answers
Question 1: When performing synchronized cardioversion for AF, the sync mode aligns the shock delivery with which ECG feature?
- The P wave
- The R wave (QRS complex) (Correct answer)
- The T wave
- The U wave
Correct answer: The R wave (QRS complex)
Synchronized cardioversion delivers the shock on the R wave to avoid the vulnerable T-wave period, which could induce ventricular fibrillation.
Question 2: The recommended initial biphasic energy setting for elective cardioversion of persistent AF in most adults is:
- 50 joules
- 100–120 joules (Correct answer)
- 200 joules
- 360 joules
Correct answer: 100–120 joules
Current guidelines recommend starting with 100–120 joules for biphasic cardioversion of AF, escalating if the initial shock fails.
Question 3: Which defibrillator self-test function must be confirmed as PASS before performing cardioversion?
- Battery capacity ≥ 50%
- Electrode impedance check
- Internal discharge test
- All of the above (Correct answer)
Correct answer: All of the above
Pre-procedure checks should confirm battery level, electrode impedance within acceptable range, and a passed internal diagnostic test.
Question 4: Anterior-posterior pad placement for AF cardioversion is preferred over anterior-lateral because it:
- Reduces skin burns
- Delivers higher current density through atrial tissue (Correct answer)
- Avoids pacemaker interference
- Decreases cardioversion time
Correct answer: Delivers higher current density through atrial tissue
Anterior-posterior placement directs the electrical vector more directly through the atria, improving shock efficacy.
Question 5: After a failed cardioversion attempt, the clinician should reassess pad contact and then:
- Decrease energy by 50 joules
- Switch to monophasic waveform only
- Escalate energy to the next level per protocol (Correct answer)
- Abort the procedure immediately
Correct answer: Escalate energy to the next level per protocol
Escalating energy in a stepwise fashion is standard protocol when initial cardioversion attempts fail.
Question 6: Transcutaneous impedance greater than 100 ohms during cardioversion setup most likely indicates:
- Full battery charge
- Poor pad-to-skin contact or dry skin (Correct answer)
- Ventricular fibrillation present
- Correct synchronization mode
Correct answer: Poor pad-to-skin contact or dry skin
High transthoracic impedance is usually caused by poor electrode contact, excessive chest hair, or dry skin, all of which reduce shock efficacy.
Question 7: Which maintenance task is required for external defibrillator/cardioverter pads stored in a clinical unit?
- Weekly impedance self-test with pads connected
- Replacing pads per manufacturer expiration date (Correct answer)
- Disinfecting pads with bleach wipes monthly
- Charging pads to full energy weekly
Correct answer: Replacing pads per manufacturer expiration date
Electrode pads must be replaced before their expiration date to ensure adequate conductivity and adhesion during use.
AF Equipment Operation & Maintenance 2
When performing synchronized cardioversion for AF, the sync mode aligns the shock delivery with which ECG feature?