Evaluation and Management of Pacing System Malfunctions

Levine, Paul A.

doi:10.1002/9780470750674.ch7

Cited by 3 publications

(5 citation statements)

References 54 publications

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“…After lead implantation, the tissue around the lead tip becomes inflamed due to the presence of foreign material in the body and due to the pressure of the lead-electrode system in contact with the myocardium. 2,41 With time, the inflammatory reaction subsides, leaving a thin capsule of fibrous tissue between the electrode and the active myocardium supplying an extra fixation of the lead tip to the myocardium. 41 However, the inflammatory reaction can be excessive, causing the capture threshold to rise, sometimes above the output of the pacemaker, causing exit block.…”

Section: Discussionmentioning

confidence: 99%

“…2,41 With time, the inflammatory reaction subsides, leaving a thin capsule of fibrous tissue between the electrode and the active myocardium supplying an extra fixation of the lead tip to the myocardium. 41 However, the inflammatory reaction can be excessive, causing the capture threshold to rise, sometimes above the output of the pacemaker, causing exit block. In this context, the use of a steroid-eluting electrode may offer benefits in terms of subacute and chronic thresholds.…”

Section: Discussionmentioning

confidence: 99%

“…Such a late dislodgment was probably related to the animal's movement and was caused by inadequate fixation of the anchoring sleeve to the lead or to the surrounding tissue, insufficient slack, or a poor fixation of the lead tip to the endocardium. 41 The latter could have been influenced by the use of the steroideluting electrode in this horse, because the elution of dexamethasone could have reduced the thickness of the fibrous capsule surrounding the lead tip.…”

Section: Discussionmentioning

confidence: 99%

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Dual‐Chamber Pacemaker Implantation via the Cephalic Vein in Healthy Equids

Loon

Fonteyne

Rottiers

et al. 2001

Veterinary Internal Medicne

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The purpose of the present study was to develop a feasible and safe technique for dual-chamber pacemaker implantation in healthy horses. Implantation was performed in a standing, tranquilized horse and in ponies. Atrial and ventricular leads were transvenously inserted through the cephalic vein, and a subcutaneous pacemaker pocket was created between the lateral pectoral groove and the manubrium sterni in 6 equids. Positioning of each lead was guided by echocardiography and by measuring the electrical characteristics of the lead. The implantation procedure lasted about 4 hours in each animal and was well tolerated. In all animals, dual-chamber pacemaker function was obtained, and these results remained good throughout the follow-up period. At the time of implantation, atrial and ventricular sensing were between 2.1 and 7.2 mV and 7.8 and 16.8 mV, respectively, and atrial and ventricular pacing thresholds at 0.5 millisecond varied from 0.5 to 0.7 V and from 0.3 to 1.0 V, respectively. Six months after the implantation, sensing values varied from 2 to 10 mV for the atrial lead and from 2 to 16 mV for the ventricular lead, while pacing thresholds at 0.5 millisecond varied from less than 0.5 to 2.5 V for the right atrium and from less than 0.5 to 5.0 V for the right ventricle. Atrial lead dislodgment occurred in 2 animals, requiring insertion of a new lead. Ventricular lead dislodgment was not observed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Dual‐Chamber Pacemaker Implantation via the Cephalic Vein in Healthy Equids

Loon

Fonteyne

Rottiers

et al. 2001

Veterinary Internal Medicne

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“…Acute threshold rise occasionally responds to systemic steroids. A regimen of prednisone, 60 mg (1 mg/kg) per day, is found to be effective in one-half of the patients (Levine, 2005 Lead insulation failure is mainly due to extrinsic forces exerted to the lead either at or following implantation. Insulation damage has reported both in silicone-and polyurethanecoated leads (Kertes et al, 1983).…”

Section: Pacing Artifact Present With Failure To Capturementioning

confidence: 99%

Pacing System Malfunction: Evaluation and Troubleshooting

Haghjoo¹

2011

Modern Pacemakers - Present and Future

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“…1 Late complications due to PM malfunctioning are uncommon. Pacing system malfunction can present as output failure ( e.g.…”

Section: Introductionmentioning

confidence: 99%

Recurrent syncope in a hypertensive subject with vascular cognitive impairment and permanent pacemaker

et al. 2012

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Syncope following permanent pacemaker (PM) implantation is a nightmare for electrophysiologists. We describe a case of daily recurrent syncope in an 84-year-old man having a dual-chamber pacemaker implanted for complete atrio-ventricular block occurred 4 years before the admission to our department. He had a history of arterial hypertension, parossistic atrial fibrillation, chronic obstructive pulmonary disease, stage-III chronic renal failure, mild vascular cognitive impairment and glaucoma. The initial work-up including electrocardiogram (ECG), repeated PM interrogations, Holter electrocardiogram, blood pressure measurement in orthostatic position, complete blood count, serum glycaemia, electrolytes and thyroid function tests showed normal findings. Syncope occurred in lying position and during 90° left clockwise neck rotation and was associated to pallor, sweating, tonic-clonic seizures and transient self-limited loss of consciousness lasting a few seconds. Electroencephalogram was normal. During continuous ECG monitoring, the right rotation of the head determined a ventricular asystolic pause lasting 9 seconds associated with loss of consciousness. Restoration of sinus rhythm was observed after bringing back the head in axis. The PM interrogation, performed during pacing failure, recorded low impedance of bipolar ventricular lead, suggesting a damage in lead insulation. It is likely that lead movements during clockwise neck rotation produced an intermittent short circuit that prevented sufficient energy delivery to the myocardium with a consequence of sudden loss of capture.

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Evaluation and Management of Pacing System Malfunctions

Cited by 3 publications

References 54 publications

Dual‐Chamber Pacemaker Implantation via the Cephalic Vein in Healthy Equids

Dual‐Chamber Pacemaker Implantation via the Cephalic Vein in Healthy Equids

Pacing System Malfunction: Evaluation and Troubleshooting

Recurrent syncope in a hypertensive subject with vascular cognitive impairment and permanent pacemaker

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