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Pseudo-elevation of conduction system pacing threshold through parallel connection of an intracardiac electrogram
Jun Yokota1, Katsuhito Fujiu2,3, Tsukasa Oshima2
1Department of Medical Engineering, The University of Tokyo Hospital, Tokyo, Japan.
Journal of Cardiovascular Electrophysiology
|June 24, 2021
Summary
Connecting an electrophysiology (EP) system in parallel with pacing equipment can unexpectedly increase pacing thresholds during conduction system pacing (CSP). Disabling the EP system's pacing function resolves this issue, preventing false CSP failures.
Area of Science:
- Cardiovascular Electrophysiology
- Medical Device Engineering
Background:
- Parallel connection of electrophysiology (EP) systems to conduction system pacing (CSP) equipment is common for monitoring and evaluation.
- Unexpected increases in pacing thresholds have been observed under specific parallel connection conditions.
Purpose of the Study:
- To investigate the mechanism behind unexpected pacing threshold exacerbation when an EP system is connected in parallel with CSP equipment.
- To evaluate the impact of EP system settings on pacing output and intracardiac electrograms.
Main Methods:
- An ex vivo model simulating cardiac pacing and electrogram monitoring was created.
- An oscilloscope, pacing system analyzer (PSA), EP system, and simulated heart were used.
- Electrical output discrepancies were measured under various equipment combinations and conditions.
Main Results:
- Parallel connection of the EP system reduced the electrical output from the PSA, as measured at the simulated heart.
- Adverse effects were pronounced with the RMC-5000 EP system when its pacing function was active.
- Disabling the EP system's pacing function completely resolved the observed reduction in electrical output.
Conclusions:
- The EP system, when connected in parallel with a PSA for CSP, has the potential to increase pacing thresholds.
- This phenomenon may lead to pseudo-failures in CSP due to artificially high pacing thresholds.
- It is recommended to turn off the pacing function of the RMC-5000 EP system when used in parallel with a PSA for CSP testing.
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