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IBRHE EXAM BUNDLE 3 LATEST VERSIONS
(VERSION A,B AND C) NEWEST 2024-2025 ACTUAL
EXAM COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+ ||
IBRHE EXAM QUESTIONS VERSION A
LV pacing is most often associated with what? - ANSWER- LV pacing is most often associated with a RBBB pattern since the depolarization starts in the LV and arrives late in the RV.
Stimulation of the RV apex and RV free wall will have what pattern? - ANSWER- Stimulation of the RV apex and RV free wall will have a LBBB pattern.
The RVOT has an inferior axis and LBBB pattern.
Which leads on the ECG represent the septum? - ANSWER- leads V1 and V2
What factors result in a positive CRT response? - ANSWER- Wide QRS width (especially when combined with LBBB morphology) 1 / 4
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Female Gender
Non ischemic cardiomyopathy as the underlying pathology of heart failure.
Less consistently echo signs of dyssnychrony were found to predict response.
What is associated with less favorable response to CRT? - ANSWER- Coronary artery disease
Think presence of ischemic cardiomyopathy as the cause of decreased LV function is clearly associated with a less favorable response to CRT (especially regarding LV reverse remodeling).
This is likely due to irreversible myocardial scarring.
Which leads represent the lateral wall? - ANSWER- Lead 1, AVL, V5 and V6 represent the lateral wall.
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Which study investigated the efficacy of a single burst of ATP (8 pulses, 88% cycle length) in VT and fast VT? - ANSWER- The PainFREE and the PainFREE II.The success rate was 85% and 72%.
Acceleration of VT's by a burst of ATP were rarely observed.Based on this data at least one burst of ATP before or during charging should be programmed in virtually all patients.
Dependent patients - ANSWER- Switch to asynchronous pacing in order to prevent oversensing from both electrocautery and device manipulation.
Application of only short bursts of electrocautery or using a bipolar cautery system will reduce the risk of over sensing.
Activity sensor should be turned off (for all patients) in order to minimize inappropriate increases in heart rate due to device manipulation.
Placement of transthoracic pacing pads.
Bipolar (NOT UNIPOLAR) pacing configurations should be used when possible, as once the generator is out of the pocket 3 / 4
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there is no longer a pacing circuit and loss of capture resulting in asystole in a pacemaker dependent patient.
Name a programming change LEAST likely to improve the likelihood of the device going into mode switch? - ANSWER- Decrease PVARP
(think shorten)
Decreasing PVARP will not increase the detection of atrial fibrillation, as events occurring during PVARP are already registered towards the mode switch count (although no AV delay is started during this period).
What would shortening the PVAB do? - ANSWER- Shortening the PVAB will potentially result in more atrial events not being blanked, which are counted towards mode switch.
Making the atrial channel more sensitive will equally lead to more atrial events being sensed.
Reducing the entry count and / or the mode switch rate will also result in a higher likelihood for the device to go into mode switch.
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