Energy Parameters in Cardiac Pacing Should Be Abandoned

The Salty Dog: Serum Sodium and Potassium Effects on Modern Pacing Electrodes

“…Does it matter how thresholds are expressed? This has been discussed in more detail elsewhere 7 . In summary, this study and previous reports demonstrate that threshold, the minimum stimulus necessary to cause all fast sodium channels in the membrane to open, is a voltage mediated phenomenon 7 .…”

“…Is it the pulse energy, duration, current, voltage, or something else? We did provide an answer to that question in a prior paper where we explained that none of the above parameters make sense as threshold mediators, except voltage 7 . The results of this study additionally clarify the issue.…”

“…Thus, if one measures threshold and determines safety factors in terms of energy, one can produce misleading results. For example, if voltage threshold has increased, increasing pulse duration to maintain “constant energy” can actually reduce safety factor 7 . How a pacemaker stimulates also affects the design of new pacemakers.…”

“…However, if voltage, not energy, is responsible for depolarization, then increasing pulse duration can be ineffective, misleading, and possibly unsafe. In fact, regardless of the energy, one cannot stimulate if the voltage is below its strength‐duration curve 7 …”

Die intraoperativ gemessene Stimulationsimpedanz von Schrittmacherelektroden ist kein Prädiktor für ihren Langzeitverlauf

“…Der theoretisch nachweisbare inverse Zusammenhang zwischen Stimulationsimpedanz und Stimulationsstrom und die damit zu erzielende Verlängerung der Funktionszeit gewinnt in der Schrittmachertherapie zunehmende klinische Bedeutung (1,10,19): Zum einen wurden speziell hochohmige Schrittmacherelektroden entwickelt (12,18), deren hohe Stimulationsimpedanz bei gleichen Stimulationsimpulsen zusätzlich den Stimulationsstrom vermindert (3,4,7). Zum anderen werden die patientenbezogenen Faktoren optimiert, z.…”