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Pulse width dependent increase in the pacemaker automatic interval.

O J Ohm, K Breivik, E Hammer

    Pacing and Clinical Electrophysiology : PACE
    |May 1, 1982
    PubMed
    Summary
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    Unexpected pacemaker rate drops occurred in 19.6% of patients. This malfunction, caused by sensing polarization voltage, necessitates changes in pacemaker filter characteristics for improved reliability.

    Area of Science:

    • Biomedical Engineering
    • Cardiology
    • Medical Device Technology

    Background:

    • Rate and pulse width adjustable pacemakers (Microlith-P 0505, Microthin-PI 0522) were implanted in 51 patients over three years.
    • A subset of patients experienced unexpected decreases in pacemaker pulse rate during pulse width adjustments.

    Observation:

    • 19.6% of patients (10/51) exhibited an unintended drop in pacemaker pulse rate.
    • The Microthin-PI 0522 model showed a higher incidence, with 53.8% (7/13) experiencing this issue.
    • Rate drops often coincided with the pulse generator's refractory period, extending the automatic interval significantly in some cases.

    Findings:

    • The abnormal pacemaker function is attributed to sensing polarization voltage at the electrode/tissue interface and/or T-waves.

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  • Mathematical analysis confirmed that polarization voltage can reach amplitudes and slew rates sufficient for pacemaker inhibition.
  • Polarization voltage is significantly influenced by the electrode/tissue interface impedance.

    • Implications:

    • Urgent modifications to pacemaker filter characteristics are needed to reduce sensitivity in low-frequency regions.
    • Reducing output circuit capacitance can mitigate polarization voltage, enhancing pacemaker reliability.
    • Two patients required pulse generator replacement due to the malfunction, highlighting the clinical impact.