Platinum pacemaker electrodes: origins and effects of the electrode-tissue interface impedance

Investigation of the unipolar properties of the paced-evoked response requires special measures to eliminate the post-stimulus potential, and this in turn requires a knowledge of the properties of the electrode-tissue interface which is not supplied by any single source in the literature. We have therefore drawn together published information and some of our own experimental results. The behavior of a particular type of pacemaker electrode was investigated in vitro under a range of conditions. The application of DC potentials revealed an extremely nonlinear voltage-current characteristic with conduction thresholds at about +1 V and -1 V. Small signal AC response to applied voltages well within these values (20 mV pk-pk) was found to be linear when a nonpolarizable counterelectrode was used. Nonlinearities were introduced by the use of a stainless steel counterelectrode. The response of an in vitro model of a paced patient to voltage pulses (amplitude 5 V, duration 0.5 ms) was also investigated. We have made extensive use of previously published work to demonstrate the mechanisms underlying these results and also their relationship to each other. We have concluded with some theoretical comments upon the design requirements for a device to eliminate the post-stimulus afterpotential in order to detect the paced-evoked response.