Cardiac Devices · Module 7 of 7

Device Troubleshooting

Technologist focusedInteractive lessonConceptual education

Practice describing device behavior, separating sensing from capture problems, and escalating findings precisely.

Learning objectives

DefineDescribe the observable device behavior before labeling the cause.
SeparateDistinguish output, sensing, capture and lead/system issues conceptually.
EscalateCommunicate specific findings to the qualified device team.

The device troubleshooting framework

OBSERVEWhat happened?
CLASSIFYSensing, output, capture, rhythm?
CROSS-CHECKECG, EGM, trends, connections
ESCALATECommunicate precisely
Scenario 1

Pacing artifact without expected QRS

Describe this as an output followed by no obvious expected ventricular capture on the available tracing. Confirm the tracing and escalate for formal device evaluation rather than changing programming independently.

Scenario 2

Intrinsic QRS appears, but device timing behaves as if it was not detected

This raises a sensing question. Correlate surface ECG with the device electrogram/markers during formal interrogation and consider whether the intrinsic event met the system's sensing criteria.

Scenario 3

Device records very rapid events that do not match the surface rhythm

Do not assume true tachyarrhythmia. Stored electrograms and marker channels are needed to evaluate possibilities such as oversensing or other signal-related behavior.

Better communication

Instead of “the pacemaker isn't working,” report the observable finding: “There is a ventricular pacing artifact without an obvious subsequent QRS on this tracing.”

What is the best first troubleshooting step?

Educational scope: Device programming, implant decisions, therapy changes, alerts and patient management require appropriately credentialed clinicians, institutional protocols, and current manufacturer instructions.
Lesson progress

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