CCS Cardiovascular Treatment Procedures 3 — Questions and Answers
Question 1: Which ablation technique is used as first-line catheter-based therapy for typical atrial flutter?
- Pulmonary vein isolation
- Cavotricuspid isthmus ablation (Correct answer)
- AV node ablation
- Superior vena cava isolation
Correct answer: Cavotricuspid isthmus ablation
Typical atrial flutter uses the cavotricuspid isthmus as an obligate part of the re-entrant circuit, making CTI ablation highly effective with >95% success rate.
Question 2: A patient with severe mitral stenosis has a pliable, non-calcified valve. The most appropriate percutaneous intervention is:
- Transcatheter mitral valve replacement
- Percutaneous mitral balloon valvuloplasty (PMBV) (Correct answer)
- Pulmonary vein isolation
- Coronary angioplasty
Correct answer: Percutaneous mitral balloon valvuloplasty (PMBV)
PMBV (also called balloon mitral commissurotomy) is the procedure of choice for suitable mitral stenosis, splitting the fused commissures to improve valve area.
Question 3: What is the primary hemodynamic goal when using a percutaneous left ventricular assist device (Impella) in high-risk PCI?
- Increase heart rate
- Unload the left ventricle and maintain cardiac output (Correct answer)
- Reduce pulmonary artery pressure only
- Provide temporary pacing support
Correct answer: Unload the left ventricle and maintain cardiac output
The Impella device directly unloads the LV by pumping blood from the LV into the aorta, maintaining systemic perfusion during high-risk interventions.
Question 4: During permanent pacemaker implantation, the pacing lead is most commonly secured in which cardiac location for ventricular pacing?
- Left ventricular epicardium
- Right ventricular apex or outflow tract (Correct answer)
- Coronary sinus
- Pulmonary artery
Correct answer: Right ventricular apex or outflow tract
Transvenous RV pacing leads are typically positioned at the RV apex or septum/outflow tract via the subclavian or cephalic vein approach.
Question 5: A patient develops cardiac tamponade after an electrophysiology procedure. The immediate treatment is:
- Emergency surgical pericardiectomy
- IV furosemide to reduce pericardial fluid
- Pericardiocentesis under echocardiographic guidance (Correct answer)
- Vasopressors alone
Correct answer: Pericardiocentesis under echocardiographic guidance
Pericardiocentesis is the emergent procedure to drain the pericardial effusion and relieve the life-threatening hemodynamic compromise of tamponade.
Question 6: Which energy source is used in cryoablation for pulmonary vein isolation?
- Radiofrequency (heat)
- Extreme cold (nitrous oxide or liquid nitrogen) (Correct answer)
- Laser energy
- Ultrasound energy
Correct answer: Extreme cold (nitrous oxide or liquid nitrogen)
Cryoablation uses extreme cold delivered via the Arctic Front cryoballoon to create circumferential lesions around pulmonary vein ostia.
Question 7: A patient with end-stage heart failure refractory to all therapies and not a transplant candidate is considered for which device?
- Implantable loop recorder
- Destination therapy LVAD (Correct answer)
- Subcutaneous ICD
- Cardiac resynchronization therapy alone
Correct answer: Destination therapy LVAD
Destination therapy LVAD (e.g., HeartMate 3) is FDA-approved as a permanent alternative to transplantation for patients with end-stage HF who do not qualify for transplant.
CCS Cardiovascular Treatment Procedures 3
Which ablation technique is used as first-line catheter-based therapy for typical atrial flutter?