CCI Pacemaker and Implantable Device Assessment 1 — Questions and Answers
Question 1: In the NBG pacemaker coding system, what does the first letter represent?
- Chamber sensed
- Chamber paced (Correct answer)
- Response to sensing
- Rate modulation
Correct answer: Chamber paced
The first position of the NBG code identifies the chamber(s) being paced: O (none), A (atrium), V (ventricle), or D (dual).
Question 2: What does the letter 'R' in the fourth position of the NBG pacemaker code indicate?
- Refractory period programming
- Rate-responsive pacing (Correct answer)
- Remote monitoring capability
- Resynchronization therapy
Correct answer: Rate-responsive pacing
An 'R' in position IV indicates rate modulation, meaning the pacemaker adjusts its rate based on physiological demand using a sensor.
Question 3: Which pacemaker mode tracks atrial activity and paces the ventricle after a programmed AV delay?
- VVI
- AAI
- VOO
- VDD (Correct answer)
Correct answer: VDD
VDD mode senses in both chambers but paces only the ventricle, tracking atrial activity and delivering ventricular pacing after the programmed AV delay.
Question 4: What is the most common primary indication for permanent pacemaker implantation?
- Ventricular tachycardia
- Symptomatic bradycardia (Correct answer)
- Atrial fibrillation with rapid ventricular response
- Hypertensive urgency
Correct answer: Symptomatic bradycardia
Symptomatic bradycardia, including sick sinus syndrome and high-degree AV block causing symptoms, is the most common indication for permanent pacemaker implantation.
Question 5: Which vascular access site is most commonly associated with pneumothorax as a complication of pacemaker lead implantation?
- Femoral vein
- Internal jugular vein
- Subclavian vein (Correct answer)
- Cephalic vein
Correct answer: Subclavian vein
Subclavian vein access carries the highest risk of pneumothorax due to its proximity to the lung apex; the cephalic vein cutdown is safer in this regard.
Question 6: In a DDD pacemaker, what does the 'D' in the third position (response to sensing) indicate?
- Dual-chamber pacing only
- The device inhibits in one chamber and triggers in the other (Correct answer)
- The device delivers defibrillation shocks
- The device is inhibited in both chambers
Correct answer: The device inhibits in one chamber and triggers in the other
In the response-to-sensing position, 'D' means dual response — the device is inhibited by ventricular sensing and triggered (tracks) by atrial sensing.
Question 7: Pacemaker syndrome is best described as symptoms caused by which of the following?
- Lead insulation failure
- AV dyssynchrony during ventricular pacing (Correct answer)
- Battery end-of-life
- Electromagnetic interference
Correct answer: AV dyssynchrony during ventricular pacing
Pacemaker syndrome occurs when ventricular-only pacing (e.g., VVI) causes loss of AV synchrony, leading to retrograde VA conduction and symptoms such as fatigue, dizziness, and hypotension.
CCI Pacemaker and Implantable Device Assessment 1
In the NBG pacemaker coding system, what does the first letter represent?