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Unexpected and undesired side-effects of pacing algorithms during exercise
Marc Strik1, Pierre Socié2, Sylvain Ploux2
1IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
Journal of Electrocardiology
|December 1, 2018
Summary
Modern pacemakers use algorithms to improve function during exercise. However, these can cause dropped P-waves in pacemaker-dependent patients and loss of biventricular pacing in CRT patients during exercise tests.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Implantable pacemakers, initially for bradycardia, must now perform during exercise.
- Modern pacemakers incorporate proprietary algorithms to optimize function and avoid issues like unnecessary pacing.
Observation:
- Proprietary pacemaker algorithms can record electrograms (EGMs) during device interrogation or remote monitoring.
- Exercise testing allows verification of algorithm function and parameter optimization based on heart rate.
Findings:
- Pacemaker algorithms can induce dropped P-waves in pacemaker-dependent patients during exercise.
- These algorithms may lead to loss of biventricular pacing in cardiac resynchronization therapy (CRT) patients during exercise.
Implications:
- Exercise testing is crucial for evaluating pacemaker algorithm performance in real-time.
- Understanding these algorithm-induced effects is vital for optimizing patient management and preventing adverse events.
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