Document Detail

A stepwise testing protocol for modern implantable cardioverter-defibrillator systems to prevent pacemaker-implantable cardioverter-defibrillator interactions.
MedLine Citation:
PMID:  10072224     Owner:  NLM     Status:  MEDLINE    
Current use of newer implantable cardioverter-defibrillators (ICDs) has changed the spectrum of pacemaker-ICD interactions and provided new tools for testing and understanding those interactions. Testing for pacemaker-ICD interactions was performed in 31 procedures involving 22 patients. The protocol included: (1) evaluation of pacemaker stimulus artifact amplitude and its ratio to that of the evoked ventricular electrogram, (2) testing for inhibition of ventricular fibrillation (VF) detection by the ICD during asynchronous pacing at maximum output, (3) evaluation by pacemaker event marker recordings of pacemaker sensing behavior while programmed to nonasynchronous mode during ventricular tachycardia (VT) or VF, and (4) evaluation of postshock interactions. Inhibition of detection of VT/VF was found in 6 of 22 patients (27.2%). Large stimulus artifact amplitude (>2 mV) or stimulus artifact:evoked QRS ratio > 1/3 had a positive predictive accuracy of 18% and 14.4%, respectively, and a negative predictive accuracy of 100% and 92.3%, respectively, for clinically significant interaction. Asynchronous pacing occurred in 16 of 31 procedures (51.6%), and was due to underdetection by the pacemaker in 4 of 16 (25%) and noise reversion in 12 of 16 (75%). Postshock phenomena occurred in 6 cases, 3 of which were clinically significant. Overall, 11 of 22 patients (50%) had clinically significant interactions discovered by this protocol, which led to system revisions in 6 and to pacemaker output reprogramming in 5. Thus, pacemaker-ICD interactions are frequently detected using a thorough and systematic protocol. Most cases can be managed by system revision or pacemaker reprogramming.
M Glikson; J M Trusty; S K Grice; D L Hayes; S C Hammill; M S Stanton
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  83     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-03-25     Completed Date:  1999-03-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  360-6     Citation Subset:  AIM; IM    
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
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MeSH Terms
Defibrillators, Implantable*
Equipment Failure Analysis
Equipment Safety
Follow-Up Studies
Heart Rate
Pacemaker, Artificial*
Reproducibility of Results
Ventricular Fibrillation / physiopathology,  therapy*

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

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