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Transthoracic DC shock may represent a serious hazard in pacemaker dependent patients
G Altamura1, L Bianconi, F Lo Bianco
1Department of Heart Disease, San Filippo Neri Hospital, Rome, Italy.
Pacing and Clinical Electrophysiology : PACE
|January 1, 1995
Summary
External defibrillation (DC shocks) frequently causes temporary pacemaker issues like loss of capture and sensing failure in patients with pacemakers. Higher shock energy increases these risks, necessitating careful consideration during cardioversion.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- External defibrillation is a common treatment for tachyarrhythmias.
- Patients with pacemakers may undergo defibrillation, posing potential risks to device function.
Purpose of the Study:
- To evaluate the effects of direct current (DC) shocks on unipolar pacemakers.
- To assess the incidence of transient loss of capture, sensing failure, and pacemaker malfunction.
Main Methods:
- 36 patients with unipolar pacemakers received external defibrillation.
- Pacing output was programmed to specific parameters.
- Loss of capture, sensing failures, and stimulation thresholds were monitored.
Main Results:
- 50% of patients experienced transient loss of capture.
- Higher peak and cumulative shock energies correlated with capture failure.
- A six-fold increase in ventricular stimulation threshold was observed post-shock.
- 41% of evaluated patients had transient sensing failure.
- Two patients required pacemaker replacement due to malfunction.
Conclusions:
- External defibrillation carries a high incidence of transient loss of capture in pacemaker patients.
- Increased shock energy and lower pacemaker amplitude are associated with capture failure.
- Pacemaker function can be significantly and temporarily impaired by defibrillation shocks.