Related Experiment Videos
Combined automatic implantable cardioverter-defibrillator and pacemaker systems: implantation techniques and
A E Epstein1, G N Kay, V J Plumb
1Department of Medicine, University of Alabama, Birmingham 35294.
Insights
Combined pacemaker and automatic implantable cardioverter-defibrillator (AICD) systems can be safely implanted. This technique ensures both devices function correctly without adverse interactions, improving patient outcomes.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Automatic implantable cardioverter-defibrillators (AICDs) prevent sudden cardiac death from ventricular arrhythmias.
- Some patients require both AICD and pacemaker implantation for conditions like bradycardia or to prevent arrhythmias.
Purpose of the Study:
- To present a mapping technique for implanting combined pacemaker and AICD systems.
- To evaluate the safety and efficacy of dual-device implantation.
Main Methods:
- Mapping the left ventricle using AICD sensing electrodes for patients needing AICD after pacemaker implantation.
- Mapping the right ventricle with a pacemaker lead for patients needing a pacemaker after AICD implantation.
- Utilizing external cardioverter-defibrillators and AICD beep monitors for lead placement and device interaction assessment.
Main Results:
- Eight patients received combined AICD-pacemaker systems with various pacemaker types.
- No inhibition of AICD arrhythmia detection or double counting was observed.
- All patients demonstrated satisfactory AICD and pacemaker function postoperatively with no device-device interactions.
Conclusions:
- Combined AICD-pacemaker systems can be implanted successfully using the described mapping techniques.
- The technology allows for satisfactory function of both devices without adverse interactions.
- This approach offers a viable solution for patients requiring both defibrillation and pacing therapies.
Abstract:
The automatic implantable cardioverter-defibrillator (AICD) effectively prevents death due to ventricular tachycardia or ventricular fibrillation. Some patients who need an AICD also require cardiac pacing to treat symptomatic bradycardia, bradycardia after defibrillation, or to provide a rate floor to reduce the frequency of bradycardia-related ventricular arrhythmias. Some patients also can benefit from antitachycardia pacing. A mapping technique to implant a pacemaker and AICD sensing leads is presented. For patients with a pacemaker who later need an AICD, the left ventricle is mapped with use of the AICD rate-sensing electrodes to identify a site at which the minimal pacemaker stimulus and maximal ventricular electrogram amplitudes are recorded. An external cardioverter-defibrillator that has amplifiers similar to those in the AICD is used to monitor the rate-sensing electrogram. For patients with an implanted AICD, pacemaker implantation is undertaken by mapping the right ventricle with the pacemaker lead while the AICD is in standby mode; the AICD beep monitor is then used to determine a site where pacemaker stimulus detection by the AICD does not occur. Eight patients underwent implantation of a combined AICD-pacemaker system (four ventricular antitachycardia pacemakers, three ventricular demand pacemakers and one atrial demand pacemaker). Neither inhibition of AICD arrhythmia detection nor double counting occurred. Satisfactory AICD-pacemaker function was shown in all patients postoperatively, and no pacemaker malfunction was observed. Thus, with currently available technology, a combined AICD-pacemaker system can be implanted with satisfactory function of both devices and without adverse device-device interactions.