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The ventricular endocardial electrogram and pacemaker sensing

S Furman, P Hurzeler, V DeCaprio

    The Journal of Thoracic and Cardiovascular Surgery
    |February 1, 1977
    PubMed
    Summary
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    Understanding changes in cardiac electrograms is crucial for pacemaker function. Acute electrograms show higher voltage and slew rates, which decrease over time, impacting pacemaker sensing and lead placement.

    Area of Science:

    • Cardiology
    • Biomedical Engineering
    • Electrophysiology

    Background:

    • Cardiac pacemaker implantation requires precise lead placement for optimal function.
    • Endocardial electrograms provide critical data for assessing lead performance and patient status.
    • Changes in electrogram characteristics over time can affect pacemaker sensing and pacing thresholds.

    Purpose of the Study:

    • To analyze and compare the characteristics of acute (at implantation) and chronic (post-implantation) unipolar, right ventricular electrograms.
    • To determine the impact of electrogram changes on pacemaker sensing and lead placement strategies.
    • To establish parameters for optimal pulse generator selection and operation.

    Main Methods:

    • Recorded unipolar, right ventricular electrograms from 133 patients during pacemaker implantation and replacement.

    Related Experiment Videos

  • Analyzed electrogram structure, peak-to-peak voltage, ST-segment displacement, and slew rate (dv/dt).
  • Utilized peripheral electrocardiogram QRS designations for endocardial electrogram waveform analysis.

    • Main Results:

    • Acute electrograms exhibited higher mean voltage (12.4 mV) and slew rate (2.9 V/s) with significant ST-segment elevation.
    • Chronic electrograms (over 6 months) showed a 15% lower voltage amplitude and a 41% lower slew rate, with no ST-segment elevation and inverted T waves.
    • Variations in QRS complex morphology were observed in both acute and chronic recordings.

    Conclusions:

    • The significant decrease in voltage amplitude and slew rate from acute to chronic electrograms necessitates accommodating these changes for adequate post-implantation sensing.
    • Understanding these electrogram dynamics is vital for optimizing electrode placement and selecting appropriate pacemaker sensitivity.
    • Failure to account for these changes may lead to satisfactory pacing thresholds but inadequate sensing, impacting overall device efficacy.