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[An inordinate elevation in pacing threshold after myocardial electrode implantation]
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|January 1, 1989
Summary
Sudden increases in pacemaker pacing thresholds occurred in four patients post-implantation, leading to pacing failure. Periodic threshold monitoring is crucial after permanent pacemaker insertion.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Permanent pacemaker implantation is a common treatment for bradyarrhythmias following open-heart surgery.
- Myocardial electrodes are utilized for pacemaker lead placement.
- Bradyarrhythmias, including complete A-V block and atrial fibrillation, necessitate pacing support.
Observation:
- Four patients experienced an acute elevation in pacing threshold post-permanent pacemaker implantation.
- This elevation exceeded the maximal output of the pulse generator in these cases.
- The patients' ages ranged from 9 months to 32 years.
Findings:
- In two infants, hypokalemia led to transient pacing failure due to a threshold increase above 5 volts.
- In two other patients, pacing thresholds exceeded 10 volts within 12-36 days, likely due to suboptimal lead placement.
- Pulse generators were removed in the latter two patients due to the high thresholds.
Implications:
- Periodic measurement of pacing thresholds is essential after permanent pacemaker implantation.
- Clinicians should consider the possibility of significant threshold elevation, especially in acute post-operative periods.
- Identifying and addressing causes of threshold elevation, such as electrolyte imbalance or lead position, is critical for successful pacemaker function.