Incessant atrioventricular dissociation due to far-field QRS oversensing and recurrent mode switch in a dual chamber pacemaker

Ambulatory Holter monitoring in asymptomatic patients with DDD pacemakers - do we need ACC/AHA Guidelines revision?

INTRODUCTION

We sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups.

MATERIAL AND METHODS

Ambulatory 24-hour Holter recordings (HM) were performed in 100 patients with DDD pacemakers 1 day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances.

RESULTS

Despite proper sensing and pacing parameters, HM revealed PM disturbances in 23 patients out of 100 (23%). Atrial undersensing episodes were found in 12 patients (p < 0.005) with totally 963 episodes and failure to capture in 1 patient (1%). T wave oversensing was the most common ventricular channel disorder (1316 episodes in 9 patients, p < 0.0005). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found.

CONCLUSIONS

Asymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation. Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogram PM parameters.

Digital Technology in Cardiac Pacing: Methods for Morphology Analysis of Sensed Endocavitary Signals

Proper functioning of a pacemaker depends exclusively on the detection of intrinsic cardiac signals. Conventional devices merely establish the presence of an endocavitary potential, but do not evaluate it qualitatively. The recent incorporation of digital signal processing of sensed events in pacemaker permits diagnostic characterization heretofore impossible.

METHODS

Digital processing was used in 268 cardiac cycles recorded from 5 patients during elective dual chamber pacemaker replacement, The signals were classified in real time by an external pacemaker equipped with hardware and software capabilities for this purpose.

RESULTS

The parameters used for morphological analysis were the minimum value of the slope signal and the minimum value of the filtered signal. The discrimination of a true atrial signal from a far-field R wave was correct in every patient (p < 0.0001).

CONCLUSION

Digital devices may monitor and classify every event continually, and dramatically increase device reliability and the amount of information that can be processed and stored.