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The Development of pacemaker programming: Memories From a Bygone Era

HEART LUNG AND CIRCULATION 2021年第2期30卷 233-239页

作者： Mond, Harry G. Univ Melbourne Dept Cardiol Royal Melbourne Hosp Melbourne Vic Australia Univ Melbourne Dept Med Melbourne Vic Australia

Programmability is a stable, reversible change in the operating parameters of a cardiac implantable electronic device. The era of non-invasive programming began in 1972, with the development of a dedicated hand-held battery-operated device. Prior to this, there had been crude attempts, involving invasive procedures or a magnet, to change the pacemaker operating parameters. A non-invasive programming system requires an implanted pulse generator and an external programmer, communicating via an energy link. This was initially a pulsed magnetic field allowing opening and closing of a reed switch in the pulse generator in synchrony with the pulses. Soon after, radiofrequency communication was introduced and involved transmission of pulsing on-off radiofrequency bursts, which allowed complex encoding, that recognised the implanted hardware, prevented mis-programming, had security features and confirmed successful programming. As programming became more complex and sophisticated, programmers evolved into desktop models with programming wands and printers. By 1978, multiprogrammable programmers with bidirectional telemetry were introduced and became a driving force in the development of new cardiac implantable technologies and devices.

关键词： pacemaker pacemaker programming Programmers

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Telemetry guided pacemaker programming:: Impact of output amplitude and the use of low threshold leads on projected pacemaker longevity

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1998年第11期21卷 2055-2063页

作者： Schwaab, B Fröhlig, G Schwerdt, H Heisel, A Berg, M Schieffer, H Univ Kliniken D-66421 Homburg Germany

In a prospective study a low threshold screw-in electrode (Medtronic 5078, group I, n = 9) was compared to a conventional active fixation lead (Biotronik Y60BP, group II, n = 9) to investigate whether lower pacing thresholds really translate into longer projected service life of the pacemaker. The leads were implanted in the atrium and were connected to a dual chamber pacing system which included the same ventricular lead (Medtronic 5024) and the same pulse generator model (Intermedics 294-03) in both groups. Eighteen months after implantation, atrial and ventricular pacing thresholds were measured as the charge delivered per pulse [mu C] at 0.5, 1.0, 1.5, 2.0, and 3.5 V, respectively. For chronic output programming in both channels, patients capturing at 0.5 V were set to 1.0 V, those capturing at 1.5 V were permanently programmed to 2.0 V with the double of the charge threshold as the safety margin for pacing ("safety charge"). A combination of atrial and ventricular output settings rr as optimal, if it resulted in minimum battery current drain [mu A] as measured by pacemaker telemetry. In both groups, current consumption [mu A] decreased significantly as output amplitude was decreased, exhibiting its lowest value at 1.0 V in either channel. All ventricular leads could be programmed to the optimum output amplitude of 1.0 V in groups 1 and 2. As the 2:1 "safety charge" values ere almost identical, the ventricular channel essentially contributes the same amount to the battery drain of the pacing system in both groups. In the atrium, all patients of group 1 could be programmed to the optimum output amplitude of 1.0 V with an average pulse duration of 0.42 +/- 0.15 ms. In group 2, however, ever, all patients had to be programmed to 2.0 V with a mean pulse width of 0.52 +/- 0.15 ms. With the atrial and ventricular output being optimized, the average battery drain of the whole pacing system was 12.19 +/- 0.63 mu A in group 1 versus 14.42 +/- 0.32 mu A in group 2 (P < 0.

关键词： battery telemetry safety margin pacemaker programming projected pacemaker longevity low threshold electrode

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Differences in pacemaker programming between electrophysiology specialists and other physicians

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Indian Pacing and Electrophysiology Journal 2023年第5期23卷 151-154页

作者： Antezana-Chavez, Edgar Flores Herrera, Tatiana Saavedra Rodriguez, Daniel Cardiology Department Hospital Belga Cochabamba Bolivia

Background: Appropriate programming of cardiovascular implantable electronic devices (CIED) is essential to ensure adequate function and avoid harmful effects. In underdeveloped countries, CIED monitoring and programming are often performed by physicians involved in their implantation. However, many of them often do not have sufficient training in CIED programming. Objective: We aimed to assess the differences in pacemaker programming between electrophysiology (EP) specialists and other physicians. Methods: We retrospectively reviewed changes in pacemaker programming performed by an EP specialist in patients who attended for pacemaker evaluation and reported previous follow-ups by a non-EP specialist. Results: Among 58 patients (26 males), 41 patients (71%) had programming errors and required setting modifications. The rate adaptative pacing function (R-mode) was incorrectly deactivated in 9 patients (15%) and improperly activated in 2 patients (3%). Unnecessary ventricular stimulation was detected in 23 patients (40%) with a pacing burden of 60% (32–95%). The lower rate limit was unnecessarily high in 12 patients (21%). Atrial or ventricular pacing output was inappropriate in 15 patients (26%) and was consequently modified (4 patients unnecessarily high, 9 patients below requirements). The auto-adapted pacing output was switched off in 17 of 18 patients (16 due to physician's preference, and 1 due to algorithm inaccuracy). The programmed sensitivity was inaccurate in 2 patients (3%). In 2 patients (3%) switching from DDDR to VVIR mode was required. Conclusion: We found a high prevalence of errors in pacemaker programming by non-EP specialists. An EP specialist should always be responsible for CIED follow-up. © 2023 Indian Heart Rhythm Society

关键词： Electrophysiology evaluation pacemaker programming Ventricular pacing burden

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pacemaker programming in patients with first-degree AV-block: programming pattern and possible consequences

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HEALTH SCIENCE REPORTS 2018年第6期1卷 e39页

作者： Holmqvist, F. Rathakrishnan, B. Jackson, L. R. Campbell, K. Daubert, J. P. Duke Univ Clin Cardiac Electrophysiol Med Ctr Durham NC 27705 USA Lund Univ Dept Cardiol Lund Sweden Columbia Univ Coll Phys & Surg 630 W 168th St New York NY 10032 USA Duke Univ Med Ctr Dept Pharm Durham NC 27705 USA

Background The optimal way of pacing in patients with an indication for pacing and concomitant first-degree atrioventricular (AV)-block is not known, and consequently, firm guidelines on this topic are lacking. This study explored the current pacemaker programming pattern in patients with first-degree AV-block who have a dual chamber pacemaker without cardiac resynchronization. Methods The study was a retrospective chart review conducted at Duke University Hospital. Patients receiving a pacemaker due to sinus node dysfunction with coexistent first-degree AV-block were studied. Baseline demographics and characteristics, as well as pacemaker programming parameters and follow-up data, were collected through chart review. Preimplantation and postimplantation electrocardiograms were analyzed. Results A total of 74 patients were included (mean age, 75 +/- 11 y;53% men). The mean +/- SD preimplant PR interval and QRS duration was 243 +/- 46 and 110 +/- 30 milliseconds, respectively. A history of atrial fibrillation was present in 49% of the patients, and 77% had a normal left ventricular ejection fraction. The majority of patients (65%) had their pacemakers programmed to atrial pacing (AAI/DDD +/-R), whereas 32% and 2.7% of the pacemakers were programmed to AV-sequential pacing (DDD) and ventricular pacing (VVI), respectively. There were no significant differences in baseline characteristics or electrocardiogram measures between patients programmed to the 3 pacing modes. Patients with pacemakers programmed to AAI had a lower ventricular pacing percentage at follow-up (8 vs 55, and 46% [DDD and VVI, respectively];P < .001). Conclusions There was no evident association between baseline characteristics and programmed pacing mode in patients with first-degree AV-block. The choice of pacing mode affects long-term pacing burden, which in turn has been shown to influence outcome.

关键词： first-degree AV-block pacemaker programming sinus node dysfunction

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APPARENT pacemaker FAILURE DUE TO REVERSION CIRCUITRY WITHIN THE programming DEVICE

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1984年第2期7卷 237-239页

作者： HAYES, DL HOLMES, DR MERIDETH, J OSBORN, MJ BARDSLEY, WT Division of Cardiovascular Diseases and Internal Medicine Mayo Clinic and Mayo Foundation Rochester Minnesota

While being evaluated for a recurrent tachyarrhythmia, a patient with a permanent pacemaker underwent reprogramming of the unit from the DVI to the VVI mode for assessment of the underlying rhythm. Subsequent reprogramming of the pacemaker to the DVI or DDD mode was impossible despite multiple attempts and the use of multiple programmers. The problem was considered to be a malfunction of the pacemaker circuitry, and plans were made for the pacemaker to be explanted and a replacement unit implanted. Before the procedure, the pacemaker company was notified of the explantation. We subsequently learned that a special programming sequence had to be carried out because of reversion circuitry present in the pacemaker but not described in the available literature. This report emphasizes the need for familiarity with each of the individual pacemakers being implanted and the need for the manufacturer to be as specific as possible given the complexity of current units.

关键词： cardiac arrhythmia pacemaker pacemaker malfunction pacemaker programming programming devices recurrent tachycardia

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Remote programming of cardiac implantable electronic devices for MRI: Are we ready to change the channel?

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JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 2022年第5期33卷 1010-1012页

作者： Amaral, Ansel P. Montgomery, Jay A. Vanderbilt Univ Med Ctr Div Cardiovasc Med Nashville TN 37212 USA

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Rate-drop response programming

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1997年第3期20卷 841-843页

作者： Gammage, MD UNIV BIRMINGHAM DEPT CARDIOVASC MEDBIRMINGHAMW MIDLANDSENGLAND

Effective programming of the rate-drop response algorithm requires careful attention to the heart rate and blood pressure responses seen during diagnostic tilt testing. In order to undertake effective programming, additional tilt testing procedures may be necessary, and it is vital that the protocol should be identical on each occasion and very careful note taken of exact times of onset of symptoms and relative timing of onset of changes in heart rate and blood pressure. The algorithm settings in the Thera DR generator as delivered (factory or ''shelf'' parameter settings) must be considered nontherapeutic (an unusual situation for a pacemaker algorithm) and will require adjustment for each individual patient. Effective therapeutic settings are likely to result in an excess of pacing interventions;these, however, tend to be less symptomatic than the syncope or presyncope suffered by the patient and are generally well tolerated or not noticed.

关键词： rate-drop response algorithm pacemaker programming syncope and presyncope

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STANDARDIZED INFORMAL EXERCISE TESTING FOR programming RATE ADAPTIVE pacemakerS

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1991年第11期14卷 1772-1776页

作者： HAYES, DL VONFELDT, L HIGANO, ST Division of Cardiovascular Diseases and Internal Medicine Mayo Clinic and Mayo Foundation Rochester Minnesota

It is essential that patients with pacemakers capable of rate modulation undergo some form of exercise testing to assure appropriate rate modulation. Informal exercise testing is a reasonable and less expensive alternative to formal treadmill testing. Empiric adjustment of the rate response parameters by assessing the patient's rate response while walking at a self-determined casual and brisk pace has been used. However, no normals exist to determine the appropriate rate response for a "casual" and "brisk" walk. Volunteers were tested with metronome-guided casual and brisk walks in an effort to standardize the informal exercise and determine expected heart rate response for these levels of activity. Results of the metronome-guided rate response in normal volunteers may be useful in determining the appropriate rate response for pacemaker patients when tested in such an informal manner.

关键词： RATE ADAPTIVE pacemaker pacemaker programming EXERCISE TESTING

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programming OF THE PACING IMPULSE IN pacemakerS CONNECTED TO STEROID LEAD SYSTEMS

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1995年第2期18卷 318-322页

作者： SCHUCHERT, A CAPPATO, R KUCK, KH MEINERTZ, T Medical Clinic Department of Cardiology University-Hospital Eppendorf Hamburg Germany

The purpose of the study was to compare the feasibility of low amplitude output programming (2.5 V/0.5 msec) 3 or more months after pacemaker implantation in patients receiving steroid and nonsteroid lead systems. Chronic pacing voltage, current, and energy thresholds were determined from 0.05- to 1.0-msec pulse duration in 44 patients with steroid lead systems, and in 36 patients with nonsteroid lead systems;all patients received pacemakers from the same manufacturer, which utilized the same programming and telemetry features. Chronaxie, pulse duration at the lowest pacing current, and energy were assessed from individual threshold curves. Steroid-eluting leads had significantly lower pacing voltage, current, and energy thresholds than nonsteroid leads. A 100% safety threshold margin could be achieved in 43 (98%) patients with steroid lead systems and in 27 (75%;P < 0.05) patients with nonsteroid lead systems with output programming of 2.5 V/0.5 msec. Chronaxie (0.22 +/- 0.17 msec vs 0.44 +/- 0.32 msec;P < 0.05 pulse duration at lowest pacing current (0.28 +/- 0.12 msec vs 0.49 +/- 0.22 msec;P < 0.05), and pulse duration at lowest pacing energy (0.31 +/- 0.17 msec vs 0.53 +/- 0.22 msec;P < 0.05) were significantly shorter for steroid than for nonsteroid lead systems. In 42 patients of the former group, a 100% safety margin could be maintained either with a 2.5 V/0.3 msec or with a 1.6 V/0.5 msec output. Conclusions Low amplitude output programming can be obtained in almost all pacemakers connected to steroid-eluting lead systems, and in a significantly higher number of patients than when connected with nonsteroid leads systems. Moreover, in most cases, a 100% safety margin can be achieved at settings as low as 1.6 V/0.5 msec or 2.5 V/0.3 msec;these different combinations offer potential different opportunies to select definitive programming and reduce pacing current requirements in patients undergoing pacemaker implantation.

关键词： STEROID ELUTING LEADS PACING THRESHOLD PACING CURRENT PACING ENERGY pacemaker programming

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programming optimal atrioventricular delay in dual chamber pacing using acceleration: Comparison with a standard echocardiographic procedure

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 2003年第1期26卷 210-213页

作者： Dupuis, JM Kobeissi, A Vitali, L Gaggini, G Merheb, M Rouleau, F Leftheriotis, G Ritter, P Victor, J Univ Hosp Angers Dept Cardiol F-49033 Angers 01 France Sorin Biomed CRM Saluggia Italy InParys Paris France

Optimization of programmed atrioventricular delay in dual chamber pacing is essential to the hemodynamic efficiency of the heart. Automatic AV delay optimization in an implanted pacemaker is highly desirable. Variations of peak endocardial acceleration (PEA) with AV delay at rest correlate well with echocardiography derived observations, particularly with end-diastolic filling and mitral valve closure timings. This suggests the possibility of devising a procedure for the automatic determination of the optimal AV delay. The aim of this study was to compare a proposed algorithm for optimal AV delay determination with an accepted echocardiographic method. Fifteen patients with high degree AV block received BEST-Living pacing systems, Automatic AV delay scans were performed at rest (60-300 ms in 20-ms steps with 60 beats per step) in DDD at 90 ppm, while simultaneously recording cycle-by-cycle PEA values, which were averaged for each AV delay to obtain a PEA versus AV delay curve. Nonlinear regression analysis based on a Boltzmann sigmoid curve was performed, and the optimal AV delay (OAVD) was chosen as the sigmoid inflection point of the regression curve. The OAVD was also evaluated for each patient using the Bitter echocardiographic method. Good sigmoid fit was obtained in 13 of 15 patients. The mean OAVD obtained by the PEA sigmoid algorithm was 146.9 +/- 32.1 ms, and the corresponding result obtained by echocardiography was 156.4 +/- 34.3 ms (range 31.8-39.7 ms). Correlation analysis yielded r = 0.79, P = 0.0012. In conclusion, OAVD estimates obtained by PEA analysis during automatic AV delay scanning are consistent with those obtained by echocardiography. The proposed algorithm can be used for automatic OAVD determination in an implanted pacemaker pulse generator.

关键词： atrioventricular delay peak endocardial acceleration pacemaker programming

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