Ventricular Cross Stimulation in a Dual Chamber Pacing System: Phenomenon Analysis

Abstract

Seven cases of ventricular cross stimulation from a group of 23 patients implanted with DDD devices are presented. In two patients the phenomenon was observed at the moment of DDD programming at nominal values, and in five other patients it was reproduced by increasing the atrial output voltage up to ten volts. In all 23 patients cross stimulation disappeared permanently within 24 hours after implantation. From the onset of cross stimulation to its end, atrial and ventricular threshold voltages were unchanged, while the atrial and ventricular impedances significantly decreased. These results suggest that an important role in the phenomenon occurs by impedance variation at the interface between the pulse generator and body tissue.

Cross‐Stimulation: A Rare Complication of Chronic Epicardial Leads

“…In all of these cases cross‐stimulation was benign and again resolved with maturation of leads and subsequent increased thresholds. As expected, lead placement is another potential cause for cross‐stimulation 3,4,7 . If the atrial lead is placed such that it is in close proximity to right ventricular myocardium, cross‐stimulation can occur.…”

“…In most reported cases with unipolar leads, given that the case is an ungrounded shared anode, initial high impedance postimplantation has resulted in a sufficient leak of current between the leads to cause cross-stimulation. 3,4 In all of these cases, as the leads matured, cross-stimulation ceased. Several cases have also been reported where the design of particular pacemakers or analyzers allowed for cross-stimulation under certain circumstances.…”

“…It was first reported by Levine et al in 1985, 3 and subsequent reports have identified multiple causes. In most reported cases with unipolar leads, given that the case is an ungrounded shared anode, initial high impedance postimplantation has resulted in a sufficient leak of current between the leads to cause cross‐stimulation 3,4 . In all of these cases, as the leads matured, cross‐stimulation ceased.…”

“…This was first described by Levine et al in 1985. 3 Since then, the majority of reported cases of crossstimulation have been caused by intrinsic design features of certain pacemaker and analyzer models, [3][4][5][6] or been associated with issues related to lead placement or trauma. 7,8 In such cases, cross-stimulation has usually followed a benign course and resolved with minimal intervention.…”

Pacemaker Troubleshooting and Follow-up

“…[269][270][271][272] Internal crossover within the pulse generator circuitry may be the cause. For all of these situations, surgical revision of the pacing system is the only option for correction.…”