IBHRE - International Board of Heart Rhythm Examiners Device Troubleshooting and Programming Questions and Answers

Question 1

A patient with a dual-chamber pacemaker for sick sinus syndrome has a device check.
The rhythm strip shows ventricular pacing spikes occurring 40ms after the peak of native, conducted QRS complexes.
This observation is most consistent with which device issue?

Accepted Answer

Ventricular undersensing

Answer

Crosstalk

Answer

T-wave oversensing

Answer

Loss of capture

Question 2

A patient with a new CRT-D device for heart failure is seen for follow-up. Device interrogation reveals a biventricular pacing percentage of only 82%. The event log shows that most of the non-paced beats are due to intrinsic ventricular conduction following a sensed atrial event. Which programming adjustment is most likely to increase the biventricular pacing percentage?

Accepted Answer

Shortening the sensed atrioventricular (AV) delay

Answer

Increasing the lower rate limit to 80 bpm

Answer

Activating a ventricular sense response feature

Answer

Lengthening the post-ventricular atrial refractory period (PVARP)

Question 3

An active patient with an ICD for primary prevention receives an inappropriate shock. The stored intracardiac electrogram (EGM) shows a stable sinus rhythm, but the ventricular sensing channel is obscured by high-frequency, non-physiologic signals that are counted in the tachyarrhythmia zone, leading to therapy. What is the most likely cause of these signals?

Accepted Answer

Lead noise from a conductor fracture or insulation breach

Answer

Atrial fibrillation with rapid ventricular response

Answer

T-wave oversensing

Answer

Pacemaker-mediated tachycardia

Question 4

A routine interrogation of a VVI pacemaker reveals intermittent pacing spikes that are not followed by a QRS complex. A threshold test is performed and shows the ventricular capture threshold is 3.5V @ 0.4ms. The device is currently programmed to an output of 2.5V @ 0.4ms. What is the most appropriate immediate programming change?

Accepted Answer

Increase the ventricular output to 4.5V @ 0.4ms

Answer

Increase the ventricular sensitivity by lowering the mV value

Answer

Decrease the lower rate limit by 10 ppm

Answer

Change the pacing mode to VVO

Question 5

A patient with a dual-chamber pacemaker for sick sinus syndrome has a device check.
The rhythm strip shows ventricular pacing spikes occurring 40ms after the peak of native, conducted QRS complexes.
This observation is most consistent with which device issue?

Accepted Answer

PMT Intervention Algorithm

Answer

Rate Smoothing

Answer

Ventricular Sense Response

Answer

Mode Switching

Question 6

Which of the following rate-response sensors functions by delivering subthreshold electrical pulses and measuring the changes in electrical resistance across the chest cavity to estimate respiratory effort?

Accepted Answer

Minute Ventilation Sensor

Answer

Accelerometer

Answer

QT Interval Sensor

Answer

Peak Endocardial Acceleration (PEA)