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Clinical interactions between pacemakers and automatic implantable cardioverter-defibrillators
H Calkins1, J Brinker, E P Veltri
1Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
Journal of the American College of Cardiology
|September 1, 1990
Summary
Interactions between pacemakers and automatic implantable cardioverter-defibrillators (AICDs) are frequent. Careful device programming and lead placement can prevent adverse clinical outcomes from these common pacemaker-AICD interactions.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Pacemakers and automatic implantable cardioverter-defibrillators (AICDs) are frequently used together.
- Seventeen percent of AICD recipients in the study had a pacemaker implanted concurrently or sequentially.
Purpose of the Study:
- To investigate the types and frequency of interactions between pacemakers and AICDs.
- To assess the clinical significance of these pacemaker-AICD interactions.
Main Methods:
- Retrospective review of patients with both pacemakers and AICDs.
- Analysis of device logs and patient records to identify interactions.
- Categorization of identified interactions into four types.
Main Results:
- Four types of interactions were observed: sensing/capture failures, AICD oversensing pacemaker output, AICD failure to detect VF due to oversensing, and pacemaker reprogramming by AICD discharge.
- Transient sensing or capture failures occurred in seven patients.
- AICD oversensing and subsequent inappropriate inhibition or reprogramming affected multiple patients.
Conclusions:
- Potentially adverse clinical interactions between pacemakers and AICDs are common.
- Routine screening for these interactions is recommended.
- Proper attention to lead placement and device programming can mitigate clinical consequences.