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Pacemaker inhibition due to anodal ring electrode contact
D Henderson1, M Maher, D Johnson
1Halifax Medical Center, Daytona Beach, Florida.
Pacing and Clinical Electrophysiology : PACE
|December 1, 1995
Summary
Pacemaker malfunction caused by lead interference led to syncope. Reprogramming the pacemaker to unipolar sensing resolved the issue, restoring proper ventricular pacing.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- A 79-year-old patient presented with syncope, a potential sign of cardiac dysfunction.
- The patient had a history of complete atrioventricular block and severe bradycardia, necessitating a permanent DDD pacemaker.
Observation:
- Surface electrocardiogram (ECG) revealed significant pauses in ventricular output, indicating asystole.
- Pacemaker diagnostics identified spurious signals originating from the anodal ring of the pacing lead.
- Fluoroscopy showed intermittent contact between the anodal ring and an abandoned lead's electrode.
Findings:
- The interaction between the pacing lead's anodal ring and the abandoned lead caused electrical interference.
- This interference mimicked intrinsic cardiac activity, leading to inappropriate inhibition of ventricular pacing.
- The spurious signals resulted in dangerous periods of asystole and syncope.
Implications:
- This case highlights the importance of considering lead-lead interactions in pacemaker malfunction.
- Reprogramming to unipolar sensing effectively resolved the interference and corrected the pacing issue.
- Awareness of such interactions is crucial for preventing syncope and ensuring patient safety.