Pacemaker Output Programming for Maximum Safety and Maximum Longevity

A multicenter study evaluated the performance of atrial and ventricular unipolar leads with porous steroid-eluting and platinized grooved electrodes. A total of 563 leads were implanted in 451 patients. These included 311 ventricular and 97 atrial steroid-eluting electrodes; and 112 ventricular and 43 atrial leads with platinized electrodes. Mean follow-up was > or = 1 year. At implant there were no significant differences in threshold parameters in either chamber. Chronically, however, the steroid-eluting lead consistently had significantly lower pacing thresholds in both chambers. For example, after 360 days implant, steroid-eluting electrodes had 0.23 +/- 0.10 msec ventricular thresholds at 0.8 V compared to 0.45 +/- 0.3 msec in the platinized group (P < 0.0001). In the atrium, the steroid-eluting lead's 6-month thresholds at 0.8 V were 0.15 +/- 0.06 msec compared to 0.9 +/- 0.8 msec for the platinized electrode (P < 0.01). The chronic ventricular QRS amplitudes were significantly greater for the steroid-eluting electrode (P < 0.0005). There were no significant differences in atrial sensing and no incidence of atrial undersensing in the study. The low and consistent thresholds of the steroid-eluting electrodes would have permitted pacing in the ventricle at < or = 2.5 V without compromising safety factor in 99.4% of the patients. The other 0.6% required 5 V temporarily. In the atrium, 100% of the patients could have been paced safely at reduced output. In spite of this, 63% of the implanters lacked the confidence to use reduced outputs.

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“…There were no significant differences in R wave ampli-PACE. Vol, 16 April fudes (steroid = 11.58 ± 5 mV, platinized = 12.22 ± 5 mV).…”

Section: Ventricular Results At Implantmentioning

confidence: 98%

Do Steroid‐Eluting Electrodes Really Have Better Performance Than Other State‐of‐the‐Art Designs?

Santini

Seta

1993

Pacing Clinical Electrophis

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“…One means of progromniing output to assure a 2:1 voltage safety factor while approximating tbe lowest current drain. (1) Set the pulse duration to the widest value allowed on the generator (Tjj (2). Set the output voltage to the lowest permissible value (VJ.…”

mentioning

confidence: 99%

Energy Parameters in Cardiac Pacing Should Be Abandoned

Barold

Stokes

Byrd

et al. 1997

Pacing Clinical Electrophis

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“…Bei stärker polarisierbaren Elektroden tritt während der Stimulation ein polarisationsbedingter Spannungsverlust (voltage drop) an der Grenzfläche Elektrode-Myokard auf, durch den spannungsbezogene Reizschwellen (Amplituden-Reizschwelle (V) bei vorgegebener Impulsdauer oder Impulsdauer-Reizschwelle (ms) bei vorgegebener Amplitude) falsch zu hoch gemessen werden (1,7,15). Das Ausmaß dieser Polarisationsverluste ist bei jedem Elektrodentyp verschieden und ändert sich mit den programmierten Amplituden-Impulsdauer-Kombinationen (18).…”

Section: Stimulationsreizschwellenunclassified

“…Im Gegensatz dazu wird die Quantifizierung der Reizschwelle in Form der abgegebenen Ladung (µC) pro Impuls durch Polarisation nicht beeinflußt, weil es keinen Ladungsverlust entlang des Elektroden-Gewebe-Überganges gibt (1,7,15). Durch die Erfassung des pro Zeit fließenden Stromes (Ladung (µC) = Strom (mA) × Impulsdauer (ms)) geht auch die Elektrodenimpedanz in dieses Konzept ein (28).…”

Section: Stimulationsreizschwellenunclassified

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Einfluß der programmierten Sicherheitsmarge auf die Funktionszeit moderner Zweikammer-Schrittmacher

Schwaab¹,

Schwerdt²,

Fröhlig³

et al. 1998

Z Kardiol

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In 55 consecutive patients with the same dual chamber pacemaker (Relay, Intermedics) and different pacing leads, the influence of different safety margins for pacing on battery current was investigated. 2.8 +/- 0.9 years after implantation, atrial and ventricular pulse-width thresholds (tRS) (ms) were determined at 0.5, 1.0, and 2.0 V, and the charge delivered at threshold was telemetered. If tRS was < 1.50 ms at 0.5 V, an amplitude of 1.0 V was programmed in the atrium and the ventricule; if tRS was < 1.50 ms at 1.0 V, then an amplitude of 2.0 V was chosen. Two times the charge threshold (2 x QRS), two times the voltage threshold (2 x URS), and three times the pulse-width threshold (3 x tRS) were programmed as the safety margins for pacing. With every safety margin, battery current (IBat) (microA) was averaged from 5 telemetric readings in D00 mode with 70 bpm. IBat was significantly lower with 2 x QRS as compared with 2 x URS (13.43 +/- 1.0 vs. 14.20 +/- 1.2 microA, p < 0.01) and as compared with 3 x tRS (13.99 +/- 1.2 microA, p < 0.05). Pacemaker longevity derived from these current data was significantly longer with 2 x QRS (112 +/- 8 months) as compared with 2 x URS (106 +/- 9, p < 0.01) and as compared with 3 x tRS (108 +/- 8, p < 0.05). If current consumption is compared intraindividually in dependance on the programmed amplitude, battery current is significantly lower at 1.0 V as compared with 2.0 V resulting in a mean reduction of 0.63 microA (-4.9%, p < 0.05) and an average gain in longevity of 5 months. This applies to every safety margin tested. Differences in battery current caused by the safety margins will translate into a greater gain in longevity in future pacemaker models with reduced internal current consumption.

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Pacemaker Output Programming for Maximum Safety and Maximum Longevity

Cited by 23 publications

References 11 publications

Do Steroid‐Eluting Electrodes Really Have Better Performance Than Other State‐of‐the‐Art Designs?

Do Steroid‐Eluting Electrodes Really Have Better Performance Than Other State‐of‐the‐Art Designs?

Energy Parameters in Cardiac Pacing Should Be Abandoned

Einfluß der programmierten Sicherheitsmarge auf die Funktionszeit moderner Zweikammer-Schrittmacher

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