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Design-dependent cross-talk in a second generation DDD pacemaker.

B B Beaver, J D Maloney, L W Castle

    Pacing and Clinical Electrophysiology : PACE
    |January 1, 1986
    PubMed
    Summary
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    Early Gemini 415A DDD pacemakers with dual anodal rings showed design-dependent "cross-talk," causing inappropriate ventricular inhibition, especially with non-Cordis leads. Newer single-anodal ring models are unaffected.

    Area of Science:

    • Cardiology
    • Biomedical Engineering
    • Medical Device Technology

    Background:

    • A unique
    • cross-talk
    • phenomenon has been identified in early Gemini 415A DDD pacemaker models.
    • This issue involves cross-inhibition of the ventricular output stimulus.
    • Early models featured dual anodal rings interconnected by a wire.

    Purpose of the Study:

    • To investigate the incidence and characteristics of cross-talk in Gemini 415A DDD pacemakers.
    • To identify factors contributing to this cross-talk phenomenon.
    • To evaluate strategies for preventing or mitigating cross-talk.

    Main Methods:

    • Analysis of clinical data from 53 patients implanted with Gemini 415A DDD pacemakers (dual anodal rings) between September 1982 and August 1984.

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  • Clinical follow-up to identify instances of cross-talk (inappropriate ventricular inhibition).
  • Comparison between pacemakers with dual anodal rings (non-Cordis leads vs. Cordis leads) and those with single anodal rings.

    • Main Results:

    • Cross-talk was observed in six patients, manifesting as inappropriate ventricular inhibition, with syncope in one.
    • All six patients with cross-talk had non-Cordis atrial and ventricular leads.
    • Cross-talk was absent in Gemini 415A units with compatible Cordis lead systems and in newer 415A pulse generators with a single anodal ring.

    Conclusions:

    • The observed cross-talk is design-dependent, occurring exclusively in Gemini 415A pacemakers with dual interconnected anodal rings.
    • This cross-talk appears to be time-dependent and associated with non-Cordis leads.
    • Reducing atrial output, using pacing modes without atrial pacing, or employing ventricular sensing can prevent cross-talk in affected patients.