| P | Presenting rhythm, rate and percent paced | - Name the presenting rhythm and its rate.
- Record the percentage of atrial and ventricular pacing since the last check.
- Note anything in the history relevant to today’s visit.
In CIED Lab: Quick look |
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| B | Battery | - Record the battery voltage and estimated longevity.
- Note whether the replacement indicator (ERI/RRT) has been reached, and when.
- Defibrillators: record the capacitor charge time.
In CIED Lab: Quick look |
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| L | Lead impedance | - Record the pacing impedance of each lead.
- Defibrillators: record the high-voltage (shock) impedance.
- Compare with previous values: a sudden rise suggests conductor fracture, a sudden fall suggests insulation breach.
In CIED Lab: Tests, with daily values in Quick look |
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| S | Sensing | - Record P-wave and R-wave amplitudes and compare with previous values.
- To measure them, lower the rate and lengthen the AV delay so the intrinsic rhythm comes through.
- This is also when you observe the underlying rhythm and judge pacing dependence. If there is no escape rhythm, or only a slow unstable one, restore pacing at once and keep backup pacing running for the threshold tests.
- Check that the programmed sensitivity is at most half the measured amplitude (a 2:1 margin).
In CIED Lab: Tests |
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| T | Thresholds | - Record the capture threshold for each chamber (volts at a given pulse width).
- Pace faster than the intrinsic rate, and shorten the AV delay for the ventricle, so every beat is paced.
- Step the output down until capture is lost, and keep a safety margin of at least 2:1.
In CIED Lab: Tests |
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| O | Observations | - Review alerts.
- Review stored episodes, both treated and monitored, and decide whether each one and any therapy was appropriate.
- Review rate histograms and trends.
In CIED Lab: Episodes, with alerts in Quick look |
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| P | Programming and printing | - Make the changes your findings call for.
- Confirm the final settings.
- Save or print the session report.
In CIED Lab: Parameters |
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