DC Cardiac Pacemaker Therapy & Management 1 — Questions and Answers
Question 1: Which condition is the most common indication for permanent pacemaker implantation?
- Atrial fibrillation with rapid ventricular response
- Premature ventricular contractions
- Complete heart block (third-degree AV block) (Correct answer)
- Sinus tachycardia
Correct answer: Complete heart block (third-degree AV block)
Complete heart block is the most common indication for permanent pacemaker implantation because the ventricles receive no electrical signals from the atria, requiring an artificial pacemaker to maintain an adequate heart rate.
Question 2: In the NBG (NASPE/BPEG Generic) pacemaker code, what does the first letter represent?
- The rate-response function
- The chamber sensed
- The programmability of the device
- The chamber paced (Correct answer)
Correct answer: The chamber paced
In the NBG pacemaker code, the first letter represents the chamber(s) being paced (A = atrium, V = ventricle, D = dual).
Question 3: A VVI pacemaker is best described as a device that:
- Paces both chambers sequentially with AV synchrony
- Paces the ventricle, senses the ventricle, and is inhibited by intrinsic ventricular activity (Correct answer)
- Paces the atrium and senses the ventricle
- Paces and senses both chambers with rate-adaptive function
Correct answer: Paces the ventricle, senses the ventricle, and is inhibited by intrinsic ventricular activity
VVI indicates Ventricle paced, Ventricle sensed, and Inhibited response — meaning the pacemaker fires only when the intrinsic ventricular rate drops below the programmed lower rate.
Question 4: What is the primary clinical advantage of dual-chamber (DDD) pacing over single-chamber ventricular (VVI) pacing?
- Lower battery consumption
- Simpler surgical implantation
- Maintenance of AV synchrony (Correct answer)
- Reduced device follow-up requirements
Correct answer: Maintenance of AV synchrony
DDD pacing maintains AV synchrony by coordinating atrial and ventricular contractions, which improves cardiac output by approximately 20–30% compared to VVI pacing.
Question 5: Which pacemaker mode is most appropriate for a patient with sick sinus syndrome and intact AV conduction?
- VVI
- AAI (Correct answer)
- DDI
- VOO
Correct answer: AAI
AAI pacing is ideal for sick sinus syndrome with intact AV conduction because only atrial pacing is needed; the AV node and ventricles function normally.
Question 6: Pacemaker syndrome is most accurately defined as:
- Infection developing at the pacemaker generator pocket site
- Symptoms caused by loss of AV synchrony during ventricular pacing (Correct answer)
- A pacemaker-induced rapid tachycardia
- Failure of the pacemaker to capture the myocardium
Correct answer: Symptoms caused by loss of AV synchrony during ventricular pacing
Pacemaker syndrome refers to symptoms (fatigue, dyspnea, hypotension, palpitations) resulting from loss of AV synchrony, most commonly associated with VVI pacing.
Question 7: The lower rate limit (LRL) in pacemaker programming is defined as:
- The fastest rate at which the pacemaker can track atrial activity
- The maximum programmable output voltage
- The minimum heart rate below which the pacemaker will begin pacing (Correct answer)
- The rate at which the pacemaker switches from DDD to VVI mode
Correct answer: The minimum heart rate below which the pacemaker will begin pacing
The lower rate limit is the minimum heart rate threshold below which the pacemaker will deliver a stimulus to prevent bradycardia.
DC Cardiac Pacemaker Therapy & Management 1
Which condition is the most common indication for permanent pacemaker implantation?