Document Detail

Importance of pacemaker noise reversion as a potential mechanism of pacemaker-ICD interactions.
MedLine Citation:
PMID:  9604244     Owner:  NLM     Status:  MEDLINE    
Numerous types of interactions between pacemakers and implantable cardioverter defibrillators (ICDs) have been described. Pacemaker outputs preventing appropriate detection of ventricular tachycardia or ventricular fibrillation by the ICD is one of the more serious. Asynchronous pacemaker activity during ventricular arrhythmias may be caused by either nonsensing of the arrhythmia or by noise reversion, which is an algorithm that causes the pacemaker to switch to asynchronous pacing when repetitive sensing at a high rate occurs. We analyzed the mechanisms underlying asynchronous pacemaker activity in ventricular arrhythmias using pacemaker telemetry during the arrhythmia. Thirty-nine induced arrhythmias from 26 different procedures in 19 patients with both pacemakers and ICDs were analyzed. Of the 39 arrhythmias, asynchronous pacemaker activity occurred in 16. The underlying mechanism was nonsensing in 4 episodes and noise reversion in 12 episodes. Clinically significant interference with detection arose on three occasions. Conditions favoring the occurrence of noise reversion include specific pacemaker models, arrhythmia cycle lengths in the range causing noise reversion of the individual pacemaker model, long noise sampling periods, and VVI pacing mode. Noise reversion can be diagnosed by telemetering the pacemaker marker channel during ventricular arrhythmias as a part of routine pacemaker-ICD interaction evaluation. It can be prevented or minimized by programming short ventricular refractory periods or using pacemakers with short retriggerable refractory periods.
M Glikson; J M Trusty; S K Grice; D L Hayes; S C Hammill; M S Stanton
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  21     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-08-07     Completed Date:  1998-08-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1111-21     Citation Subset:  IM    
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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MeSH Terms
Bradycardia / therapy
Defibrillators, Implantable* / adverse effects
Electrodes, Implanted
Equipment Failure
Evaluation Studies as Topic
Pacemaker, Artificial* / adverse effects
Prospective Studies
Tachycardia, Ventricular / therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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