Programming Pacing Protocols through EP-WorkMate (PVC on HIS)

Transcription

1 AFD Training Programming Pacing Protocols through EP-WorkMate (PVC on HIS) The intent of this activity is to utilize the P-Functions provided by the EP-4 Stimulator to program a HIS synchronized PVC. These functions can be accessed through the Stim screen on EP-WorkMate or the Touch Screen. A HIS synchronized PVC is a discriminating maneuver that is often used when ruling out AVNRT or AVRT during tachycardia. The theory behind the maneuver is if a PVC is delivered when the HIS is refractory, it should not advance the atrial signal because the impulse is blocked at the HIS level. If the atrial signal is advanced, it suggests there is an accessory connection allowing the PVC impulse to bypass the AV Node and reach the atrium. Due to the timing of this maneuver, it is ideal to have the function programmed for quick delivery time. 1. Begin new study: Select from main menu. This will display the EP-WorkMate Opening Menu to enter patient information. It should be noted that both the Patient Name and ID Number are required to start a study. See Figure 1.1 for steps Figure 1.1 Item Rev A Page 1 of 7

2 2. Type in patient name in correct format (Last, First, MI) 3. Type in ID Number a. This is the patients unique medical records number 4. Select Begin New Study 5. Check Demonstration Signals option (at bottom right of screen) 6. Select Start at top right of screen 7. Open Stim window on review screen by clicking on the icon or selecting S hotkey. See Figure 1.2 for step 7 7 Figure Choose the F8-Arrhythmia tab. See Figure Figure Click in the Train Type box and with the up and down arrows on the keyboard, change to Sensed. See Figure 1.4 for steps 9-14, a. This will tell the system to sense the intrinsic rhythm for the set amount of drive train beats. 10. Set the Rest Time to 1 second. That tells the system to rest for 1 second before it begins to analyze the intrinsic rhythm for the next drive train and S2 delivery. 11. Set your # in Train to 3 or 4. That is how many intrinsic beats the stimulator will look at before delivering a stimulus. 12. Set the Pre-Int I/D to -10 ms. That tells the system to decrement 10 ms after each programmed PVC. 13. Set Auto to ON in the Protocol Initialization Parameters box. This simply means that when the specific pacing protocol is selected, the increment/decrement function will be on. 14. Set channel 2A to pace from RVA by checking the box next to the lead name box and changing the site to 2. Item Rev A Page 2 of 7

3 Figure Follow the instructions below to set the pacing channel. Skip to Step 19 if this function is already able to be performed. See Figure 1.5 for steps Left click on the label 16. Search for RVA in lead name box 17. Select check box for RVA 18. Press OK a. When in a live case, confirm the lead pin outs match where the catheter cable is connected to the Junction Box Figure 1.5 Item Rev A Page 3 of 7

4 The next step is to set the synchronization parameters. Setting the Sync to External in the Synchronization box on the Stim screen enables the stimulator to look for a trigger that is connected to the ECG input connector on the back of the stimulator. Setting the Sync to ON in the Protocol Initialization Parameters box of the Stim screen simply means that when that specific pacing protocol is selected, the Sync function will always be on. When deciding which lead to Stim Sync from, it is important to analyze the ECG s and EGM s on the Real Time Screen and select a signal that has a large R or V wave. That will be the signal that the simulator analyzes when delivering the stimulus. 19. Select External in the Synchronization area of the Stim screen. See Figure Turn Sync ON in the Protocol Init Parameters area of the Stim Screen. See Figure 1.4 Next we need to select an EGM to be analyzed as the Stim Sync trigger. See figure When a consistent, large R or V wave is identified, right click on the lead label 22. Select Stim Sync from the Right Click Menu a. Notice (S) is now displayed next to the lead label Figure Now that the protocol is programmed, it must be saved as a P-Key. Select from the Stim window on the review screen. See figure 1.7 for step Figure 1.7 Item Rev A Page 4 of 7

5 24. Choose which P-Key you would like to program to be your PVC on HIS pacing protocol by left clicking on the blue bar that displays NONE next to the P-key label. There are nine programmable keys and one programmable burst key. See figure 1.8 for step Figure 1.8 a. During this step, EP-WorkMate copies the programmed F8 Arrhythmia Induction pacing protocol that was just programmed and pastes it to the selected P key. During this process, the F8 tab is no longer highlighted blue, however the selected P-Key tab is highlighted blue. See figure Click on the Menu tab. See figure Choose See figure 1.10 Figure 1.9 Item Rev A Page 5 of 7

6 26 Figure Select the P-key you are programming by clicking on the protocol name. See figure 1.11 for steps Select 29. Rename the P-Key PVC on HIS 30. Select Enter on the keyboard 31. Select Figure 1.11 a. The P-key that was programmed should now be called PVC on HIS on the Stim Window. Item Rev A Page 6 of 7

7 This customization must be saved at the CathMap level if you want this programmed P-key to be available next time this CathMap is selected. 32. Enter the screen. See figure 1.12 for steps Click on once more Figure 1.12 This process can be used to program several pacing protocols that are often used in the electrophysiology lab. The key is to always save the programmed protocol at the CathMap level and keep in mind that the protocol must be programmed for each CathMap. **This exercise is to be used exclusively with the EP-4 Stimulator. The functions mentioned in the exercise cannot be performed with other stimulators. Item Rev A Page 7 of 7