| Low settings of the ventricular pacing output in patients dependent on a pacemaker: are they really safe? | |
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MedLine Citation:
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PMID: 12075256 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: It is generally acknowledged that pacemaker output must be adjusted with a 100% voltage safety margin above the pacing threshold to avoid ineffective pacing, especially in patients dependent on pacemakers. AIMS: The aim of this prospective crossover study was to assess the beat-to-beat safety of low outputs in patients who are dependent on a pacemaker between 2 follow-up examinations. METHODS: The study included 12 patients who had received a DDD pacemaker with an automatic beat-to-beat capture verification function. The ventricular output at 0.4 milliseconds pulse duration was programmed independently of the actual pacing threshold in a crossover randomization to 1.0 V, 1.5 V, and 2.5 V for 6 weeks each. At each follow-up, the diagnostic counters were interrogated and the pacing threshold at 0.4 milliseconds was determined in 0.1-V steps. The diagnostic pacemaker counters depict the frequency of back-up pulses delivered because of a loss of capture. During the randomization to 1.0-V output, we evaluated whether the adjustment of the output under consideration of the >100% voltage safety margin reduced the frequency of back-up pulses. RESULTS: Pacing thresholds at the randomization to 1.0-V, 1.5-V, and 2.5-V output were not significantly different, with 0.7 +/- 0.3 V at 2.5-V output, 0.6 +/- 0.2 V at 1.5-V output, and 0.6 +/- 0.2 V at 1.0-V output. The frequency of back-up pulses was similar at 2.5-V and 1.5-V output, 2.2% +/- 1.9% and 2.0% +/- 2.0%, respectively. The frequency of back-up pulses significantly increased at 1.0-V output to 5.8% +/- 6.4% (P <.05). Back-up pulses >5% of the time between the 2 follow-ups were observed in no patient at 2.5 V, in 1 patient at 1.5 V, and in 5 patients at 1.0 V. At the randomization to the 1.0-V output, 6 patients had pacing thresholds of 0.5 V or less, and 6 patients had pacing thresholds >0.5 V. The frequency of back-up pulses in the 2 groups was not significantly different, 6.4% +/- 8.6% and 5.7% +/- 2.6%. CONCLUSIONS: The frequency of back-up pulses was significantly higher at 1.0-V output than at 1.5-V and 2.5-V output. This also applied to patients with pacing thresholds of < or =0.5 V. Fixed low outputs seem not to be absolutely safe between 2 follow-ups in patients who are dependent on a pacemaker, even when the output has a 100% voltage safety margin above the pacing threshold. When patients with pacemakers programmed to a low ventricular output have symptoms of ineffective pacing, an intermittent increase of the pacing threshold should be carefully ruled out. |
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Authors:
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Andreas Schuchert; Jens Frese; Ekkehard Stammwitz; Miroslav Novák; Arthur Schleich; Stefan M Wagner; Thomas Meinertz |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: American heart journal Volume: 143 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2002 Jun |
Date Detail:
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Created Date: 2002-06-20 Completed Date: 2002-07-18 Revised Date: 2006-02-27 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 1009-11 Citation Subset: AIM; IM |
Affiliation:
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University-Hospital Hamburg-Eppendorf, Hamburg, Germany. schuchert@uke.uni-hamburg.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Calibration Cardiac Pacing, Artificial / adverse effects*, methods, standards Cross-Over Studies Female Heart Block / complications, therapy* Humans Male Pacemaker, Artificial Prospective Studies Safety |
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