PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 2181842

Stepwise approach to the unknown pacemaker ECG.

A Garson
View original source ↗Export metadata ↓

Abstract

A method is presented for obtaining data about a pacemaker from a routine ECG without any prior information about the type of pacemaker or the pacemaker parameters. The method begins with assessment of the mode of the pacemaker (AAI, VVI, VDD, DVI, or DDD) and the presence of physiologic sensing. After the mode is determined, pacemaker parameters are estimated: LRLI for all pacemakers, as well as AV interval, LRLI, and post-ventricular atrial refractory period for dual-chambered pacemakers. Finally, pacemaker function is analyzed to determine if an emergency exists, such as ventricular noncapture or ventricular nonsensing. This method should benefit practitioners who are faced with unknown patients, unknown pacemakers, or both, and may serve as a tool for teaching how to analyze the pacemaker ECG.

Explore related subjects

Cardiac Pacing, ArtificialElectrocardiographyEmergenciesEquipment DesignHumansPacemaker, ArtificialTerminology as TopicJournal ArticleResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.Review

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

A Garson. 1990. Stepwise approach to the unknown pacemaker ECG.. https://doi.org/10.1016/s0002-8703(05)80333-3

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Medium-term follow-up and modes of failure following epicardial pacemaker implantation in young children.

AIMS: Young children suffering from congenital or post-operative AV-block require life-long pacemaker stimulation. Due to the anatomical prerequisites initially epicardial electrodes are implanted and the generator is placed in the upper abdominal wall. The following study investigated modes of failure leading to reoperation in this group of technically challenging patients. METHODS AND RESULTS: Between October 2000 and May 2005, a total of 21 infants (age 3 days to 5 years) underwent pacemaker implantation using a subxyphoidal incision for newborns (and a partial lower or complete median sternotomy for older children). Nine patients had previous cardiac surgery for complex congenital defects. The remaining 12 young children suffered from congenital AV-Block (CAVB). Twenty-one bipolar epicardial electrodes (Medtronic Capsure epi) were fixed to the right ventricle, 15 had additional implantation of a bipolar atrial lead. The pacemaker generator (Medtronic Kappa 701) was implanted into the right upper abdominal wall. Indications for revision were recorded. No mortality was observed; pacing and sensing parameters remained stable up to a 5-year follow-up. A total of four reoperations occurred. Three of the four revisions were caused by ventricular electrode fracture. At revision, two electrodes were broken at the crossing between the pericardial cavity and the abdominal wall, one bipolar lead at the Y-division into the two tip electrodes. One reoperation was due to a pacemaker recall. All revisions were performed without complications. CONCLUSION: In our institute epicardial pacing in young children was associated with a satisfactory clinical outcome, but also a significant number of failures leading to reoperation, mainly due to electrode fracture caused by the muscular activity of this patient group. Reoperations were performed at a low risk.

Cardiac Pacing, Artificial↗
PubMed2007

Spectral pulsed-wave tissue Doppler imaging lateral-to-septal delay fails to predict clinical or echocardiographic outcome after cardiac resynchronization therapy.

AIMS: The current study sought to assess if pre-implantation lateral-to-septal delay (LSD) > or =60 ms assessed by spectral pulsed-wave myocardial tissue Doppler imaging (PW-TDI) could predict successful long-term outcome after cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Sixty patients (72% males, mean age 59 +/- 10 years) who were referred for CRT according to the ACC/ESC guidelines were enrolled in the study. All patients underwent spectral PW-TDI before and 1 year after CRT. Two left ventricular (LV) dyssynchrony time intervals, T(O) and T(P) (time to onset and peak of LV myocardial velocity, respectively), LSD were recorded. Left ventricular dyssynchrony was defined as LSD > or =60 ms. Clinical response was defined as an improvement in >1 NYHA class plus improvement in 6-min walk distance (6MWD) > or =25%, echocardiographic response was defined as a > or =15% reduction in LV end-systolic volume (LV-ESV). One year after CRT, 50 patients (83%) were clinical responders and 47 patients (78%) were echocardiographic responders. Both T(O) and T(P) LV dyssynchrony indices failed to predict echocardiographic CRT outcome. In addition, there were no significant differences between 'synchronous' and 'dyssynchronous' patient populations at baseline or follow-up in either clinical (NYHA class and 6MWD) or echocardiographic (LV ejection fraction, LV end-diastolic, and end-systolic) variables. CONCLUSION: The great majority of patients referred for CRT benefit clinically from it. However, spectral PW-TDI failed to predict CRT outcome. When PW-TDI dyssynchrony was applied for selection of proper CRT patients, up to 80-86% of the patients with synchronous LSD that had proven clinical and echocardiographic benefit from CRT would have been denied CRT.

Cardiac Pacing, Artificial↗