Pacemaker troubleshooting

There are currently more than 3 million patients worldwide with implanted pacemakers, and indications for implants are expanding. Pacemakers today are smaller (23-30 g) and fashioned in a more physiologic shape so as to be less obtrusive. They are replete with sophisticated diagnostic and programming features that make troubleshooting of complicated arrhythmias easier. Advanced nurse clinicians need to have a basic understanding of pacemaker function, indications for implantation, an awareness of potential complications, and facility with basic troubleshooting...

No abstract text is available yet for this article.

PURPOSE OF REVIEW: The purpose of this review is to provide an update on stored diagnostic information furnished by new model pacemakers and implantable cardioverter-defibrillators (ICDs). This information provides crucial information about both device function and arrhythmias discovered with device interrogation and is invaluable when troubleshooting problems with devices. RECENT FINDINGS: The most recent generation of pacemakers and ICDs provides extensive diagnostic data regarding both device and lead function...

This case report describes a patient with biventricular pacemaker in whom a far-field sensing of left atrial activity by the pacemaker's ventricular channel resulted in ventricular pacing inhibition. Placing of the left ventricular pacing electrode in the proximal part of the coronary sinus tributary resulted in this far-field sensing problem, which was resolved following decreasing the ventricular sensitivity. The authors suggest that the far-field sensing of the left atrial activity should be kept in mind for troubleshooting of an atrio-biventricular pacing system...

Biventricular ICDs may offer increased benefit for patients with severe congestive heart failure and ventricular arrhythmia. Currently there are no approved dedicated biventricular ICDs available. Twenty-one consecutive patients who had approved nondedicated hardware implanted for biventricular pacing and defibrillation were included in this study. All device therapies were evaluated using stored electrograms. During mean follow-up at 13 +/- 7 months, 8 (36%) patients had inappropriate shocks. Ventricular fibrillation therapy was delivered for slow ventricular tachycardia because of double counting in two patients...

Asymptomatic dysfunction of cardiac pacing systems is not uncommonly detected using long-term ambulatory monitoring techniques. We report two patients with atrial and ventricular sensing abnormalities noted only on Holter monitoring. Multiple empirical attempts at pacemaker reprogramming based on deductive analysis of the pacing anomaly were unsuccessful. Through the use of a new digital recording system that allowed collection of surface electrocardiographic data, intracardiac electrograms, and Marker Channel data a correct diagnosis was made (pacing lead insulation failure)...

BACKGROUND: Pacemaker marker annotations facilitate the interpretation of device behavior in addition to ECG recordings. However, they are only available in conjunction with a programmer. We studied the diagnostic value of a prototype Telemetry Holter Decoder (THD), providing continuous marker annotations on a conventional Holter. METHODS: The study included 20 patients with VDD or DDDR pacemakers. A 24-hour Holter was performed using the THD. Marker annotations are transmitted from the pacemaker to the THD, which transforms them into analog signals, which are recorded on one of the Holter channels...

Find out how they work, how to recognize their activity on an ECG, troubleshooting tips, and what patients need to know.

PURPOSE: To present a case of apparent interference of an ECG monitor by radiofrequency interference (RFI) and to provide a brief review of RFI issues to critical care medicine. CLINICAL FEATURES: A 74-yr-old woman, with an implanted pacemaker, underwent major spinal surgery. In the post-anaesthesia care unit, the cardiac monitor demonstrated graphic evidence of pacemaker malfunction but there was no apparent effect on the patient. Investigation by the hospital's biomedical personnel led to the conclusion that RFI was being interpreted by the monitor as abnormal pacemaker activity...

Emergency cardiac problems are a frequent and significant occurrence in the daily life of the emergency physician. The first part of this article discusses some of the pearls and pitfalls of caring for the cardiac patient ranging from treating wide-complex tachycardia and troubleshooting pacemaker malfunction to diagnosing acute myocardial infarction in the setting of bundle branch blocks. The second part of this article updates the reader on several of the newer technologies and treatments, such as transesophageal echocardiography and intravenous amiodarone, now in use in the emergency department setting...

BACKGROUND: It is clear that permanent cardiac pacing in patients with sick sinus syndrome is effective. In spite of a normal pacemaker function, syncope may occur. Causes often remain unknown. The objective of this study was to review our current experience with these patients to identify predictors and etiologies of these symptoms. METHOD AND RESULTS: We studied 153 patients who received atrial, ventricular and dual-chamber pacemakers for sick sinus syndrome. During a median follow-up of 57...

Many pacemaker patients have vague symptoms following implantation. It is often difficult for the physician to ascertain if they are cardiac in origin. A new pacemaker feature has been introduced, Patient-Triggered Event Records (PTER), to help the physician with this diagnosis. The PTER is a continuously running event record which stores the cardiac rhythm and rate. Brief application of a magnet will transfer the record into the device's memory. The data recorded will be the 97 events prior to the magnet application and the 30 events following magnet removal...

Sinus node dysfunction requiring permanent pacemaker implantation is a common problem following heart transplantation. There are unique problems to consider in pacing the transplanted heart. This report describes a case of far-field sensing of atrial flutter in the recipient atrial remnant, with resultant inhibition of the atrial pacemaker in the donor atrium, and symptomatic bradycardia. Although postulated to be a potential problem, oversensing of the recipient atrium has not been reported prior to this case...

The Ventritex Cadence is a fourth generation implantable cardioverter defibrillator that provides for retrieval of stored electrograms related to therapy. In two patients, this feature enabled us to troubleshoot sensing lead problems, in one instance before it became clinically apparent. This may be an important consideration in selecting an appropriate device.

The automated studies performed at implant require little extra time and provide essential information for postoperative troubleshooting and patient management. The automated testing and analysis system is but one component in a comprehensive patient management system designed for and dedicated to pacing; the system is an integral part of a complete data management system which includes extensive follow-up and management sections.

The functions of many of today's dual-chamber pacemakers are performed using custom microprocessors that are similar to those used in mainframe computers. The data storage and transmission capabilities of these microprocessor-controlled pacemakers can be used to record, process, and transmit information regarding the patient, pacemaker, or patient/pacemaker interaction. The limitations of such data processing systems depend upon (1) quantity and quality of incoming information, (2) software routines for data collection, and (3) the amount of available random access memory (RAM)...

A variety of commercial pacemaker system analyzers have been used to evaluate the electrical performance of pulse generators prior to implant or at the time of reoperation for pacemaker malfunction. We evaluated the ability of seven commercially available pacemaker system analyzers to provide the data required to determine if a given pulse generator was operating according to its manufacturer's specifications. While all pacemaker system analyzers provided accurate data for rate and pulse duration, values displayed for amplitude and sensitivity were inconsistent due to the methods each pacemaker system analyzer employed to measure these parameters...

Great advances in pacemaker technology have produced devices capable of a vast array of physiologic adaptations formerly unimaginable, opening new possibilities in the pacemaker treatment of almost all rhythm disturbances. Nearly all units in use today are of the inhibited type, except for some antitachycardia applications. The AV-sequential mode (DVI) allows for preservation of AV synchrony, and the universal pacemaker (DDD) allows for a more physiologic response to a range of atrial rates. Programmability of numerous parameters has added a new dimension of adaptability to a variety of changing physiologic needs and pacemaker performance patterns, eliminating the need for surgical revision in many cases...

Understanding upper rate responses should not be a frustrating experience. A thorough working knowledge of DDD pacer timing cycles is recommended before attempting to assimilate this information. Anyone involved in the interpretation and troubleshooting of DDD pacer ECGs should be familiar with these four basic upper rate responses. As shown in Table I, these responses are used to limit the upper ventricular tracking rate in various pacer models either as a single option or in combination. The operation of combined upper rate responses can be difficult to interpret...

No abstract text is available yet for this article.