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Differences in pacemaker programming between electrophysiology specialists and other physicians

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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The Development of pacemaker programming: Memories From a Bygone Era

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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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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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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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Heart rate distribution in dogs with third degree atrioventricular block and rate responsive pacemakers

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JOURNAL OF VETERINARY CARDIOLOGY 2022年第0期43卷 70-80页

作者： Pires, A. Raheb, S. Monteith, G. Colpitts, M. E. Chong, A. O'Sullivan, M. L. Fonfara, S. Univ Guelph Dept Clin Studies Ontario Vet Coll 50 Stone Rd East Guelph ON N1G 2W1 Canada Univ Prince Edward Isl Dept Compan Anim Atlantic Vet Coll 550 Univ Ave Charlottetown PE C1A 4P3 Canada Toronto Vet Emergency Hosp 21 Rolark Dr Scarborough ON M1R 3B1 Canada

Introduction: In dogs, single lead ventricular pacing, ventricular sensing, inhibition response, rate adaptive (VVIR) pacemakers are routinely used to treat third degree atrioventricular block (3AVB). The objectives of this study were to investigate the heart rate distribution in dogs with VVIR pacemakers, and report changes when activity settings were adjusted. Animals: Eighteen client-owned dogs with VVIR pacemakers for 3AVB. Materials and methods: This observational study consisted of a review of medical records of dogs with VVIR pacemakers. For dogs with >50% of paced beats at the lower pacing rate the activity daily living (ADL) and exertion responses were in-creased. Re-evaluations were performed after 6-12 months. Results: Heart rate distribution similar to healthy dogs was absent for all dogs. In nine dogs the ADL and exertion responses were increased to the highest level. Of these, three dogs showed no improvement in heart rate distribution;for two dogs, one with an epicardial pacemaker, several activity settings were adjusted and pacing at higher heart rates was observed at re-evaluation. Four dogs died or were lost to follow-up. Clinical signs had resolved for all dogs after pacemaker implantation. Conclusion: Default activity settings of VVIR pacemakers do not result in heart rate distribution equivalent to healthy dogs. Increasing the ADL and exertion response set-tings to the highest levels did not improve the pacemaker rate response. Further in-vestigations into the role of dog size, generator positioning, pacemaker settings, and whether rate responsiveness is required for dogs's quality and quantity of life, are warranted. (C) 2022 Elsevier B.V. All rights reserved.

关键词： Bradyarrhythmia Canine Exercise pacemaker programming VVIR

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Repetitive nonreentrant ventriculoatrial synchrony inducing atrial fibrillation in setting of dofetilide

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HeartRhythm Case Reports 2022年第5期8卷 320-324页

作者： Garber, Leonid Shulman, Eric Kushnir, Alexander Saraon, Tajinderpal Park, David S. Chinitz, Larry A. organization Leon H. Charney Division of Cardiology Cardiac Electrophysiology NYU Langone Health New York University Grossman School of Medicine New York New York United States

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First-in-human combined transcatheter tricuspid valve implantation with leadless VDD pacemaker via left internal jugular approach

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HeartRhythm Case Reports 2022年第3期8卷 155-159页

作者： Hale, Benjamin W. Bradley, David J. Zampi, Jeffrey D. Whiteside, Wendy Cunnane, Ryan Michigan Medicine C.S. Mott Children's Hospital Congenital Heart Center Ann Arbor MI United States Michigan Medicine Cardiovascular Center Ann Arbor MI United States

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Electrical abnormalities with St. Jude/Abbott pacing leads: A systematic review and meta-analysis

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HEART RHYTHM 2021年第12期18卷 2061-2069页

作者： Khatiwala, Roshni V. Mullins, Elizabeth Fan, Dali Srivatsa, Uma N. Dhruva, Sanket S. Oesterle, Adam Univ Calif Davis Dept Internal Med Sacramento CA 95817 USA Univ Calif Davis Dept Internal Med Div Cardiol Sacramento CA 95817 USA Univ Calif San Francisco San Francisco Vet Affairs Med Ctr Dept Internal Med Div Cardiol 4150 Clement StBldg 203Room 2A-25 San Francisco CA 94121 USA

BACKGROUND Although there is a paucity of contemporary data on pacemaker lead survival rates, small studies suggest that some leads may have higher malfunction rates than do others. OBJECTIVE The purpose of this study was to determine the malfunction rates of current pacemaker leads. METHODS A meta-analysis including studies that examined the non-implant-related lead malfunction rates of current commercially available active fixation pacemaker leads was performed. An electronic search of MEDLINE/PubMed, Scopus, and Embase was performed. DerSimonian and Laird random effects models were used. RESULTS Eight studies with a total of 14,579 leads were included. Abbott accounted for 10,838 (74%), Medtronic 2510 (17%), Boston Scientific 849 (6%), and MicroPort 382 (3%) leads. The weighted mean follow-up period was 3.6 years. Lead abnormalities occurred in 5.0% of all leads, 6.1% of Abbott leads, 1.1% of Medtronic, 1.4% of Boston Scientific, and 5.5% of MicroPort. The most common lead abnormality was lead noise with normal impedance. Abbott leads were associated with an increased risk of abnormalities (relative risk [RR] 7.81;95% confidence interval [CI] 3.21-19.04), reprogramming (RR 7.95;95% CI 3.55-17.82), and lead revision or extraction (RR 8.91;95% CI 3.36-23.60). Abbott leads connected to an Abbott generator had the highest abnormality rate (8.0%) followed by Abbott leads connected to a non-Abbott generator (4.7%) and non-Abbott leads connected to an Abbott generator (0.4%). CONCLUSIONS Abbott leads are associated with an increased risk of abnormalities compared with leads of other manufacturers, primarily manifesting as lead noise with normal impedance, and are associated with an increased risk of lead reprogramming and lead revision or extraction.

关键词： Lead malfunction Lead noise Lead extraction pacemaker lead pacemaker programming

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Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience

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HEART RHYTHM O2 2021年第5期2卷 455-462页

作者： Arps, Kelly Piccini, Jonathan P. Yapejian, Rebecca Leguire, Rhonda Smith, Brenda Al-Khatib, Sana M. Bahnson, Tristram D. Daubert, James P. Hegland, Donald D. Jackson, Kevin P. Jackson, Larry R., II Lewis, Robert K. Pokorney, Sean D. Sun, Albert Y. Thomas, Kevin L. Frazier-Mills, Camille Duke Univ Med Ctr Div Cardiovasc Dis Sect Cardiac Electrophysiol Durham NC USA Duke Clin Res Inst Durham NC USA Durham VA Med Ctr Durham NC USA

BACKGROUND Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described. OBJECTIVE To describe pacing outcomes and programming changes with AV-synchronous leadless pacemakers in clinical practice. METHODS Consecutive patients without persistent atrial fibrillation who received an AV-synchronous leadless pacemaker and completed follow-up between February 2020 and April 2021 were included. We evaluated tracking index (atrial mechanical sense followed by ventricular pace [AM-VP] divided by total VP), total AV synchrony (sum of AM-ventricular sense [AM-VS], AM-VP, and AV conduction mode switch), use of programming optimization, and improvement in AV synchrony after optimization. RESULTS Fifty patients met the inclusion criteria. Mean age was 69 +/- 16.8 years, 24 (48%) were women, 24 (48%) had complete heart block, and 17 (34%) required >= 50% pacing. Mean tracking index was 41% 6 34%. Thirty-five patients (70%) received >= 1 programming change. In 36 patients with 2 follow-up visits, tracking improved by 19% +/- 28% (P value for improvement 5.09) and 118% +/- 19% (P = .02) among 15 patients with complete heart block. Average total AV synchrony increased from 89% [67%, 99%] to 93% [78%, 100%] in all patients (P = .22), from 86% [52%, 98%] to 97% [82%, 99%] in those with complete heart block (P 5.04), and from 73% [52%, 80%] to 78% [70%, 85%] in those with >= 50% pacing (P = .09). CONCLUSION In patients with AV-synchronous leadless pacemakers, programming changes are frequent and are associated with increased atrial tracking and increased AV synchrony in patients with complete heart block.

关键词： Leadless pacemaker Mechanical atrial sensing Atrioventricular synchrony Complete heart block pacemaker programming

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Electrocardiographic interpretation of pacemaker algorithms enabling minimal ventricular pacing

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HEART RHYTHM 2020年第10期17卷 1784-1792页

作者： Mond, Harry G. Univ Melbourne Royal Melbourne Hosp Dept Cardiol Parkville Vic Australia CardioScan Pty Ltd Camberwell Vic Australia

Cardiac pacing from the apex of the right ventricle has been shown to result in left ventricular dysfunction, atrial fibrillation, and increased mortality. To counter these effects, one of the strategies developed is avoidance of ventricular pacing when not necessary, using programmable algorithms to minimize ventricular pacing. Seven algorithms are available from 5 manufacturers. Four of the manufacturers have mode conversion algorithms that pace AAI(R) but, in the presence of failed atrioventricular (AV) conduction, demonstrate algorithm-offset and convert to DDD(R) with ventricular pacing. Three manufacturers do not have mode conversion but rather AV extension to encourage AV conduction. Each of these algorithms has a unique design and, when ventricular pacing is present, will regularly schedule conduction testing to encourage AV conduction and hence algorithm-onset. All of these algorithms seem to violate the rule of AV conduction by allowing the AV delay for sensed ventricular events to be longer than for ventricular paced events. The result is frequently bizarre electrocardiographic (ECG) appearances that often are unique to the company's algorithm but also suggest pacemaker malfunction. This review highlights and illustrates the features of these algorithms as they appear on ECG, and discusses other situations that result in unintended ventricular pacing.

关键词： Atrioventricular delay Cardiac failure Electrocardiography Minimize ventricular pacing pacemaker algorithms pacemaker programming

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