Pacemaker Follow-up Exam Name: ____________________

1. The mode of operation of the above pacemaker is:

a. VVI
b. VDD
c. VDI
d. DDI

2. In order to do an atrial sensing test to the above patient you would have to:
a. Raise the lower rate before starting the test
b. Lower the lower rate before starting the test
c. Start the test without any changes
d. Extend the AV before starting the test

3. In order to do an atrial capture test to the above patient you would have to:
a. Raise the lower rate before starting the test
b. Lower the lower rate before starting the test
c. Start the test without any changes
d. Extend the AV before starting the test

4. In order to do an ventricular capture test to the above patient you would have to:
a. Raise the lower rate before starting the test
b. Shorten the AV delay before starting the test
c. Start the test without any changes
d. Extend the AV before starting the test

5. In order to do an ventricular sensing test to the above patient you would have to:
a. Raise the lower rate before starting the test
b. Shorten the AV delay before starting the test
c. Start the test without any changes
d. Extend the AV before starting the test
6. The above patient is being tested for intrinsic R-wave amplitudes. The AV delay was extended
to its maximum value of 350ms as seen above. In order to measure intrinsic R waves you would
now do what?
a. Press the start test button and measure R-waves
b. Lower the lower rate limit and then start the test
c. Shorten the AV delay to 90ms and then start the test
d. Change mode to VVI 40 and start the test

7. Based on the above patient’s test results the pacemaker should be programmed to:
a. 1.50V output in the ventricle
b. 2.50V output in the ventricle
c. 3.00V output in the ventricle
d. 3.50V output in the ventricle
8. Based on the above patient’s test results the pacemaker should be programmed to:
a. 1.0V output in the atrium
b. 1.25V output in the atrium
c. 2.50V output in the atrium
d. 3.00V output in the atrium

9. The above pacemaker is most likely programmed to what mode?

a. VVI
b. DDI
c. VDI
d. VDD
10. If the above strip represents a retrograde conduction test and based on the test’s results you
would have to program PVARP to what value?
a. 400 ms
b. 425 ms
c. 450 ms
d. none of the above
11. If a 32 year old complete heart block patient had a retrograde conduction time of 400 ms and an
AV delay of 200 ms his maximum tracking rate would be:
a. 100 ppm
b. 120 ppm
c. 130 ppm
d. 150 ppm
12. The above patient’s indication is SSS with normal AV conduction. Based on what you see above
the AV delay should be programmed to:
a. 100ms
b. 150ms
c. 175ms
d. 225ms
13. The above patient’s lower rate limit should be programmed to:
a. 50 bpm
b. 70 bpm
c. 100 bpm
d. 120 bpm

14. To make the above patient’s ventricular threshold test easier to interpret the:
a. Lower rate limit needs to be decreased
b. Lower rate limit needs to be increased
c. AV delay needs to be lengthened
d. AV delay needs to be shortened
15. If the above test had been a ventricular threshold test what parameter would need to be
adjusted in order to accurately perform the test?
a. AV delay
b. Ventricular sensitivity
c. Lower rate limit
d. Ventricular refractory period

16. If the above strip represents a retrograde conduction test and based on the test’s results you
would have to program PVARP to what value?
a. 400 ms
b. 225 ms
c. 150 ms
d. 120 ms
17. Knowing what you now know about the above patient and the PVARP was programmed to 120
ms, loss of atrial capture could lead to what?
a. Loss of ventricular capture
b. Cross talk
c. Far-field oversensing
d. PMT
18. The above patient’s most likely indication for pacing is:
a. 1st degree AV Block
b. 2nd degree AV Block
c. 3rd degree AV Block
d. Accelerated junctional rhythm

19. In order to do the above patient’s atrial threshold test based on the ECG strip above, you would
have to first:
a. Reprogram the mode to AAI
b. Extend the AV delay
c. Increase the lower rate
d. Decrease the lower rate
20. Looking at the above test strip and knowing that the device is pacing at its upper rate limit until
loss of ventricular capture occurs, what could you conclude about this patient’s rhythm during
the test?
a. He was in PMT
b. The patient suffers from paroxysmal atrial tachy arrhythmia
c. Rhythm was normal atrial tracking during the test
d. The device had mode switched

21. Looking at the above patient’s atrial threshold test you can conclude loss of atrial capture by:
a. Change in the surface morphology
b. Loss of the atrial intracardiac EGM signal
c. Presence of a retrograde atrial event
d. All of the above
 Ar Ar Ar Ar Ar Ar Ar Ar
As As As As As As As As As

22. The above patient was exercising when this ECG strip was taken. Patient complained of sudden
fatigue. From what you see above, what adjustment should you make in this patient’s
pacemaker?
a. Decrease the patient’s max tracking limit
b. Increase the AV delay
c. Increase atrial sensitivity
d. Decrease PVARP

23. Looking at the above patient’s rhythm strip, what would be your next move to confirm
ventricular capture?
a. Shorten the AV delay
b. Increase the ventricular output
c. Reprogram to VVI 40
d. Increase the ventricular sensitivity
24. To do a ventricular R-wave measurement for the above patient you would have to:
a. Decrease the lower rate limit
b. Increase the AV delay
c. Decrease the AV delay
d. Increase the lower

25. The above dual chamber ECG strip shows a definite problem with:
a. Atrial sensing
b. Ventricular sensing
c. Atrial capture
d. Ventricular capture
26. To address the above problem you would want to:
a. Increase the atrial sensitivity
b. Increase the ventricular sensitivity
c. Increase the atrial output
d. Increase the ventricular output

27. The DDD pacemaker shown above has a ventricular lead impedance of 160 Ohms. Based on
this information you are most likely facing:
a. Exit block
b. Temporary increase in pacing threshold
c. Lead insulation break
d. Lead conductor fracture
28. To address this problem you will need to try:
a. Pacing unipolar
b. Increasing pacing output
c. Increasing the sensitivity
d. Programming the device to VOO

29. The above ECG is an example of:

a. Normal pacemaker function
b. Ventricular undersensing
c. Ventricular oversensing
d. Atrial undersensing

30. The above patient was implanted with a dual chamber pacemaker last night for CHB. How
would you characterize his pacemaker function today?
a. Atrial lead dislodgement
b. Cross talk with safety pacing
c. Ventricular lead oversensing
d. Normal pacemaker function