Feasibility of concomitant implantation of permanent transvenous pacemaker and defibrillator systems

Adverse Interactions between ICD and Permanent Pacemaker Systems

“…Extensive testing for interactions is an essential part of the implantation procedure, if two CIEDs are left active [Sticherling et al, 1997;Walker et al, 2000;Cohen et al, 1988;Glikson www.intechopen.com Modern Pacemakers -Present and Future et al, 1999;Blanck et al, 1994]. This is also necessary even if the explantation of one device is already planned and the presence of the two devices together is of limited duration.…”

“…In practice a structured step by step approach is helpful. An exemplary protocol was evaluated by Glikson et al and was used by others in a modified form [Sticherling et al, 1997;Walker et al, 2000;Cohen et al, 1988;Glikson et al, 1999;Blanck et al, 1994]: 1. Assessment of oversensing of pacemaker artifacts: the predominant criterion to accept a newly positioned ventricular lead is the analysis of pacemaker spikes by the ICD.…”

“…2. Increased sensitivity of the ventricular PM lead is programmed to guarantee pacemaker detection of ventricular tachyarrhythmias with low amplitude and therefore the occurrence of fixed rate stimulation is prevented, especially during VF [Cohen et al, 1988;Blanck et al, 1994]. However it is important to rule out oversensing of myopotentials by provocation testing especially in patients who are permanently dependent on their pacemaker.…”

“…The maximum rate of PMstimulation must not exceed the detection rate of the ICD, as this could lead to inadequate detection of tachycardias and possible ICD-therapy [Brode et al, 1997;Blanck et al, 1994;Chamberlain-Webber et al, 1994] a shortening of the AV-delay is to be considered. However a short AV-delay may deteriorate the hemodynamic situation and the proportion of ventricular stimulation can be increased, which is usually not desired.…”

“…5. The stimulation output of the PM should be minimized just ensuring an adequate safety margin for effective pacing [Blanck et al, 1994]. Thus the individual stimulation energy has to take the results of the threshold and interaction testing into account.…”