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P-wave sensing in VVI pacemakers: useful or a problem?
L M van Gelder1, M I el Gamal, C H Tielen
1Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Pacing and Clinical Electrophysiology : PACE
|October 1, 1988
Summary
Pacemaker oversensing caused total inhibition in an 84-year-old patient. Reprogramming the pacemaker mode to VVT resolved the issue by preventing P-wave oversensing.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Pacemaker inhibition can occur due to various factors, including lead issues and programming parameters.
- VVI pacing mode provides ventricular pacing and sensing, which can be susceptible to inappropriate sensing of non-ventricular signals.
Observation:
- An 84-year-old female patient experienced complete inhibition of her bipolar VVI pacemaker.
- This inhibition was linked to programming the pulse generator to its highest sensitivity setting (0.6 mV).
- P-wave oversensing was identified as the cause of the pacemaker inhibition, despite a normally positioned ventricular lead.
Findings:
- Programming a VVI pacemaker to maximum sensitivity (0.6 mV) led to P-wave oversensing and total pacemaker inhibition.
- Decreasing pacemaker sensitivity could prevent oversensing, but an alternative solution was sought.
- Switching the pacing mode from VVI to VVT effectively converted the pacemaker to an atrial synchronous ventricular pacing system, resolving the oversensing issue.
Implications:
- P-wave oversensing is a potential complication of VVI pacing, especially at high sensitivity settings.
- Pacemaker mode conversion (e.g., VVI to VVT) can be a viable strategy to manage oversensing issues.
- Careful pacemaker programming and mode selection are crucial for ensuring appropriate cardiac pacing and preventing adverse events.