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Design dependent loss of telemetry: uplink telemetry hold
B S Lindenberg1, C A Hagan, P A Levine
1Section of Cardiology, St. Clare's Hospital, Schenectady, New York.
Pacing and Clinical Electrophysiology : PACE
|May 1, 1989
Summary
Loss of bidirectional telemetry in cardiac pacing, termed "uplink telemetry hold," prevents programmer communication with pacemakers. This critical issue, potentially causing magnet-induced total output inhibition, necessitates pulse generator replacement.
Area of Science:
- Biomedical Engineering
- Cardiovascular Technology
- Implantable Electronic Devices
Background:
- Bidirectional telemetry is crucial for interrogating pacemaker parameters and accessing diagnostic data in modern cardiac pacing systems.
- Effective communication between the programmer and pacemaker is essential for patient management and device optimization.
Observation:
- Two Medtronic SymbiosR pacemakers exhibited a loss of pacemaker-to-programmer telemetry capability.
- This telemetry loss was attributed to a design anomaly termed "uplink telemetry hold."
- The condition is triggered by a specific sequence of sensed events and internal pacemaker timings.
Findings:
- "Uplink telemetry hold" is irreversible in a clinical setting once activated.
- A significant risk associated with this condition is the potential for total output inhibition when a magnet is applied.
- The "cancel magnet" command activation is a prerequisite for initiating the "uplink telemetry hold" sequence.
Implications:
- Pacemakers experiencing "uplink telemetry hold" require immediate pulse generator replacement due to safety concerns.
- This finding highlights the need for robust design validation to prevent such critical failures in implantable cardiac devices.
- Understanding the specific event sequence is vital for troubleshooting and preventing future occurrences of telemetry loss.