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Automatic implantable defibrillator discharge resulting from routine pacemaker programming.

C Gottlieb1, J M Miller, M E Rosenthal

  • 1Hospital of the University of Pennsylvania, Cardiovascular, Philadelphia 19104.

Pacing and Clinical Electrophysiology : PACE
|March 1, 1988
PubMed
Summary
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An automatic implantable cardioverter-defibrillator (AICD) can be triggered by pacemaker programming signals. This unexpected AICD discharge occurred during routine pacemaker testing, highlighting potential device interactions.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • A patient with idiopathic dilated cardiomyopathy, drug-refractory ventricular arrhythmia, and high-degree AV block received an AICD and a VVI pacemaker.
  • Management involved a VVI pacemaker and an AICD for arrhythmia control and heart block.

Observation:

  • During pacemaker threshold testing, the device was reprogrammed to "stat" VVI mode.
  • Seven seconds post-reprogramming, the AICD delivered a shock.
  • The AICD discharge timing correlated with its predetermined charge time.

Findings:

  • The AICD discharge was triggered by pacemaker programming signals, not by a subsequent arrhythmia.
  • Device interrogation revealed no other rhythm disturbances.
  • The effective rate, accounting for pacemaker stimuli and QRS complexes, remained below the AICD's trigger threshold.

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Implications:

  • Pacemaker programming signals can inadvertently trigger AICD discharges.
  • This highlights the importance of understanding device interactions in patients with multiple cardiovascular implants.
  • Further investigation into electromagnetic interference and device communication protocols is warranted to prevent unintended shocks.