Page 712 - Cardiac Nursing

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688 PA R T I V / Pathophysiology and Management Disease
P - Program
I - Interrogate P P P P P P P P
100
% Pacing/day
Atrial 75
Ventricular 50
25
0
>120
Avg V. rate (bpm)
Day 100
Night 80
60
<20
>8
Patient activity
hours/day 6
4
2
0
>200
Heart rate
variability (ms) 160
120
80 ■ Figure 28-36 Printout of Medtronic’s Car-
diac Compass report from an InSync Sentry
<40
7299. The CRT-D monitors heart rate, activity
Mar May Jul Sep Nov Jan Mar
level, heart rate variability, and fluid volumes.
2007 2008 This data assists in managing the heart failure
patient.
Cardiac Compass Report
P - Program P P P P P P P P P
I - Interrogate
200
OptiVol fluid
index
OptiVol
threshold 160
120
80
40
Fluid 0
Mar May Jul Sep Nov Jan Mar
2007 2008
energy-storing capacitor, and a high-voltage output switch circuit. therapy resulting in syncope or sudden death. Lead failure may
A header made of epoxy is the interface between the generator and also cause the ICD to sense lead noise, causing inappropriate
the leads (Display 28-7). 72 shocks, and subsequent psychological distress. 75
The lead system connects the generator to the heart. Lead ICD leads are now smaller, are steroid eluting to help
technology has markedly improved; however, the lead system is achieve lower pacing thresholds, and provide better sensing,
the most vulnerable aspect of the ICD system and the most which is a critical function of the ICD. 76,77 When a single-
frequent cause of system failure. Long-term lead failure rate has chamber ICD is placed, only one lead is required and it is
been noted to be as high as 20% in 10-year-old leads. ICD lead placed into the right ventricle in the same manner as a pace-
failure may result in the ICD not properly sensing and delivering maker lead. The ventricular lead has sensing and pacing