Pacemaker troubleshooting: improved efficacy using a new diagnostic digital Holter recording system (original) (raw)
Related papers
Cardiac pacemakers: Evaluation and management of malfunctions
The American Journal of Emergency Medicine, 2000
The emergency physician may be called on at any time to evaluate a patient with a pacemaker. Although current models are very reliable, malfunctions occur. This review discusses the basic components of the antibradycardic pacemaker, which malfunctions can be expected to occur, and how to evaluate an improperly functioning unit. In addition, recommendations for disposition are discussed. (Am J Emerg Med 2000;18:435-440.
Pacemaker Follow-Up: Its Role in the Detection and Correction of Pacemaker System Malfunction
Pacing and Clinical Electrophysiology, 1986
GRIFFIN, J.C., ET AL.: Pacemaker follow-up: its role in the detection and correction of pacemaker system malfunction. The goal of pacemaker foUow-up is not only to detect battery depletion but also to detect all malfunctions of the pacing system and, when possible, to correct such problems using programming. During one year, we discovered 61 such inal/unctions in a clinic of W65 patients (5.7%). These were more frequent in the first year {7.7%) than in the third io fifth years of foWow-up (range 3.1-4.8%). The incidence rose again in the sixth and subsequent years {7-7.7%). Despite a significant occurrence of malfunctions (5.2%J among muKiprogrammable pacemakers, the necessity for operative intervention for their correction was low (1.2%). Sensing problems were the most common {57%) and the most likely io be corrected hy reprogromming (85%]: problems involving loss of capture were less likely io he corrected by programming (38.5%). Baiiery depletion accounted for only 18% of malfunctions, occurring earliest in (he forty-tbird month of foIJow-up. Pulse generator longevity of those devices reaching end of battery life during the sfudy period was 68.6 ± W.7 months (mean + SD). We conclude that specialized pacemaker follow-up continues io he necessary des[i[te improved pulse generator reliobility and longevity. Indeed, with reprogramming, ii presently plays an even more important vole than in the past. Follow-up should he oriented noi only to the detection of battery depletion but also toward o comprehensive surveillance of pacemaker system function. (PACE, Vol. 9, May-/une, 1966) pacemaker artijiciaJ, pacemaker follow-up, pacemaker clinic, pulse generator, pacing eledrode
Pacemaker malfunction or non-physiological ventricular pacing?
Europace, 2008
Pacemaker manufacturers have developed new algorithms to preserve intrinsic conduction in order to reduce unnecessary stimulation and looking for physiological pacing. This case report highlights some of the new challenges related to these algorithms which include possible ECG misinterpretations and inaccurate programming leading to potential negative consequences.
Pace-pacing and Clinical Electrophysiology, 1997
Stored data in implantable pacemakers have rarely been used as a diagnostic tool because of the complexity. Our group bas developed software called AIDA, providing an automatic interpretation of data stored in memories of the Chorus (ELA medical) pacemaker. We com pared the results of AIDA analysis to surface ECG Holter interpretation in 59 patients (age 75 ± 9 years). In 33 cases, neither AIDA nor the Holter found any anomaly. Eleven patients demonstrated episodes of supraventricular tachycardia (SVT), confirmed by AIDA in ten patients; AIDA failure was due to nonsustained episodes of SVT not inducing mode switch. Loss of atrial sensing, pacemaker-mediated tachycar dia, and ventricular extrasystoles were detected by AIDA in ten patients. Traditional Holter missed three cases. This initial study confirms that stored pacemaker data, automatically interpreted can provide reli able information over a 24-hour period.
Abnormal or unexpected function of pacemakers due to mechanical failure of the implantation, electrical failures of the battery and electrodes, or physiological failures to respond to the stimulus may cause harm to a patient. A novel Bayesian decision tree algorithm is proposed to detect two types of pacemaker failures, nonsense and non-capture, without a priori knowledge of pacemaker type, model, or programming. A variety of pacemaker devices and modes were studied, including devices with single and dual chamber pacing; single and dual chamber sensing; and fixed rate and rate adaptive pacing. 12-lead ECG signals were acquired from 34 pacemaker patients at rest. These signals were annotated by a team of experts. A 10-fold cross-validation was performed on the data set to test the algorithm. Out-ofsample sensitivity and specificity of 87.8% and 98.7%, respectively, were achieved. This work shows that nonsense and non-captures pacemaker failures can be detected with high sensitivity and specificity without prior knowledge of the pacemaker type, model or programming, making this algorithm clinically relevant in emergency room environments where such pacemaker information may be unavailable.
Computer diagnosis of the heart - pacemaker interface
Measurement, 1989
The object of the so-called Electrocardiographic Inverse Problem is the algorithmic analysis and diagnosis of the electrocardiogram (ECG). A part of this general problem is the Pacemaker Inverse Problem, which means the analysis of the ECG in order to establish details of heart-pacemaker interaction (HPI) with special reference to the diagnosis of pacemaker failure. The solution to this problem is of practical importance, because it is often impossible to evaluate such records clinically. The ECG patterns of natural cardiac activity and of the events stimulated by the pacemaker may not be distinguishable and many combinations of potential response of the implanted device have to be taken into account. A computer system providing automatic analysis of the HPI, based on ECG data, has been developed and implemented on an IBM PC AT computer. The system uses a complex algorithm which enables the evaluation of all possible combinations of HPI events, and establishes for each of these combinations its correspondence to the specified pacemaker algorithm. The system is written in Turbo Pascal and its source text has more than 11000 lines.
Pacing and Clinical Electrophysiology, 1990
SARMIENTO, ].].: Clinical Utility of Telemetered Intracardiac Electrograms in Diagnosing a Design Dependent Lead Malfunction. Inhibition o/pacemakers due to false signals from malfunctioning pacing leads has been previously reported. Three cases are reported in which inappropriate pauses were observed shortly following implantation. In all three cases, active fixation leads with an electronically active screw and ring tip electrode were used. All leads were manufactured by Oscor Medical, St. Petersburg, Florida. In case one, models PY-61 (ventricle) and PY-51 (atrium) were used. In case two, models PY-61 were used in the ventricle and the atrium. In case three, models PY-52 were used both in the atrium and ventricle. Thresholds at the time 0/implantation were acceptable. In cases one and (wo, inappropriate pauses ivere noted following paced ventricular beats. In case three, inappropriate inhibition of the ventricular output was noted intermittently after some of the paced atrial beats. Spurious signals were identified as the cause of the apparent oversensing problem by using electrocardiograms with annotated telemetry information and noninvasively telemetered intracardiac electrograms. The amplitude of the spurious signals varied between 2 and 14 mV. In all cases, the problems resolved with time. A mechanism for the generation of false transients is proposed and the value of telemetered intracardiac electrograms is discussed.
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2008
Correct pacemaker (PM) diagnosis of paroxysmal atrial tachyarrhythmias is crucial for their prevention and intervention with specific atrial pacing programmes. The PM mode switch to only ventricular pacing after detection of atrial tachyarrhythmias is often used as the parameter to quantify the 'burden' of atrial tachyarrhythmias. This review addresses potential errors in the detection and diagnosis of atrial tachyarrhythmias, sometimes resulting in incorrect mode switches. The interpretation of PM-stored data of patients with atrial tachyarrhythmias and the results of trials of pace prevention and intervention can be better appreciated with more insight into the technical options and pitfalls. Literature and clinical experience demonstrate that the correctness of PM-derived diagnosis of atrial tachyarrhythmias depends on 1) the sensitivity setting to detect the onset and perpetuation of atrial tachyarrhythmias frequently characterised by variable and low-voltage signals, 2)...
Postmortem in situ diagnosis of pacemakers and electrodes to detect dysfunction
Legal Medicine, 2003
Cardiac pacemakers usually are very reliable, but sometimes malfunctions of the system occur. We conceived and developed a method to judge the functionality of pacemaker systems in deceased patients. The idea was to verify the hypothesis that more dysfunctions of implanted pacemaker systems go undetected than are detected and corrected. With the aid of a pre-amplifier and a digital storage oscilloscope, pacemaker pulse signals are derived from the surface of the thorax. The derived pulse shape offers information on the functionality of pacemakers and electrodes. Additionally the lead impedance is measured with a test pacemaker and its corresponding hand-held programmer. Synchronization properties can also be assessed with an external test pacemaker. So far 262 pacemakers have been investigated yielding an anomaly rate of 15%, comprising life threatening to annoying malfunctions. These results emphasize the forensic relevance and give reason for a discussion about the natural cause of death in these cases.