The recommendation and subsequent implantation of a pacemaker constitutes a therapeutic prescription with the same long-term responsibility for the periodic assessment of the continued appropriateness of that therapy as with the prescription of any pharmacologic agent. The multiplicity of programmable options available in the modern pacemaker allows the physician to titrate the dose of pacing in a manner similar to the periodic adjustment of the dose of a medication. A prime example is renal failure which commonly requires a decrease in the dose of some medications necessitated by a reduction in renal clearance, this same condition may require an increase in the programmed output of the pacemaker if the patient is prone to hyperkalemia because of associated rises in the capture threshold. This chapter will review multiple aspects and techniques associated with the routine follow-up of the pacing system including biventricular systems.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Griffin JC, Schuenemeyer TD, Pacemaker follow-up: An introduction and overview, Clin Prog Pacing Electrophysiol 1983; 1: 30–39.
Levine PA, (ed), Proceedings of the Policy Conference of the North American Society of Pacing and Electrophysiology on programmability and pacemaker follow-up programs, Clin Prog Pacing Electrophysiol 1984; 2: 145–191.
Castellanet MJ, Garza J, Shaner SP, Messenger JC, Telemetry of programmed and measured data in pacing system evaluation and follow-up, J Electrophysiol 1987; 1: 360–375.
Levine PA, Love CJ, Pacemaker diagnostics and evaluation of pacing system malfunction. In Ellenbogen KA, Kay GN, Wilkoff BL, (eds) Clinical Cardiac Pacing (second edition). Philadelphia, W. B. Saunders Publishers, 1999; Chap. 30.
Stassen J, Ector H, de Geest H, The underlying heart rhythm in patients with an artificial pacemaker, PACE 1982; 5: 801–807.
Levine PA, Why programmability? Indications for and clinical utility of multiparameter programmable pacemakers. Sylmar, CA, Pacesetter Systems, Inc., 1981.
Strathmore NF, Mond HG, Noninvasive monitoring and testing of pacemaker function, PACE 1987; 10: 1359–1370.
Bernstein AD, Irwin ME, Parsonnet V, et al., Report of NASPE policy conference on antibradycardia pacemaker follow-up: Effectiveness, needs and resources, PACE 1994; 17: 1714–1729.
Levine PA, Schuller H, Lindgren A, Pacemaker ECG utilization of pulse generator telemetry–a benefit of space age technology. Siemens Pacesetter, Inc., Sylmar CA, 1988.
Kruse I, Markowitz T, Ryden L, Timing markers showing pacemaker behavior to aid in the follow-up of a physiologic pacemaker, PACE; 1983: 6: 801–805.
Olson W, McConnel M, Sah R, et al., Pacemaker diagnostic diagrams, PACE 1985; 8: 691–700.
Levine PA, Pacemaker diagnostic diagrams (letter), PACE 1986; 9: 250.
Furman S, The ECG interpretation channel (editorial), PACE 1990; 13: 225.
Olson WH, Goldreyer BA, Goldreyer BN, Computer-generated diagnostic diagrams for pacemaker rhythm analysis and pacing system evaluation, J. Electrocardiol 1987; 1; 376–387.
Levine PA, Sholder JA, Duncan JL, Clinical benefits of telemetered electrograms in assessment of DDD function, PACE 1984; 7: 1170–1177.
Clarke M, Allen A, Use of telemetered electrograms in the assessment of normal pacemaker function, J Electrophysiol 1987; 1: 388–395.
Levine PA, The complementary role of electrogram, event marker and measured data telemetry in the assessment of pacing system function, J Electrophysiol 1987; 1: 404–416.
Gladstone PJ, Duxbury GB, Berman ND, Arrhythmia diagnosis by electrogram telemetry: Involvement of dual chamber pacemaker, Chest 1987; 91: 115–116.
Marco DD, Gallagher D, Noninvasive measurement of retrograde conduction times in pacemaker patients, PACE 1988; 11: 1673–1678.
Hughes HC, Furman S, Brownlee RR, Del Marco C, Simultaneous atrial and ventricular electrogram transmission via a specialized single-lead system, PACE 1984; 7: 1195–1201.
Feuer J, Florio J, Shandling AH, Alternate methods for the determination of atrial capture thresholds utilizing the telemetered intracardiac electrogram, PACE 1990; 13: 1254–1260.
Sarmiento JJ, Clinical utility of telemetered intracardiac electrograms in diagnosing a design dependent lead malfunction, PACE 1990; 13: 188–195.
Nalos PC, Nyitray W, Benefits of intracardiac electrograms and programmable sensing polarity in preventing pacemaker inhibition due to spurious screw-in lead signals, PACE 1990; 13: 1101–1104.
Gladstone PJ, Duxbury GB, Berman ND, Arrhythmia diagnosis by electrogram telemetry, involvement of dual chamber pacemakers, Chest 1987; 91: 115–116.
Sanders R, Martin R, Frumin H, et al., Data storage and retrieval by implantable pacemakers for diagnostic purposes, PACE 1984: 7: 1228–1233.
Levine PA, Lindenberg BS, Diagnostic data: an aid to the follow-up and assessment of the pacing system, J Electrophysiol 1987; 1: 396–403.
Hayes DL, Higano ST, Eisinger G, Utility of rate histograms in programming and follow-up of a DDDR pacemaker, Mayo Clin Proc 1989; 64: 495–502.
Levine PA, Sholder JA, Florio J, Obtaining maximal benefit from a DDDR pacing system: a reliable yet simple method for programming the sensor parameters of Synchrony. Siemens Pacesetter, Inc., Sylmar, CA, 1989.
Levine PA, Utility and clinical benefits of extensive event counter telemetry in the follow-up and management of the rate-modulated pacemaker patient. An introduction to PDx model 3037a software. Siemens Pacesetter, Inc., Sylmar CA, Feb 1992.
Newman D, Dorian P, Downar E, et al, Use of telemetry functions in the assessment of implanted antitachycardia device efficiency, Am J Cardiol 1992; 70: 616–622.
Stangl K Sichart U, Wirtzfeld A, et al., Holter functions for the enhancement of the diagnostic and therapeutic capabilities of implantable pacemakers. Vitatext, Dieren, The Netherlands, Vitatron Medical 1987; 1–6.
Levine PA, Holter and pacemaker diagnostics. In Aubert AE, Ector H, Stroobandt R (eds), Cardiac Pacing and Electrophysiology, A Bridge to the 21st Century. Dordrecht, The Netherlands, Kluwer Academic Publishers, 1994; 309–324.
Novak M, Smola M, Kejrova E, Pacemaker built-in Holter counters match up to ambulatory Holter recordings. In Sethi KK (ed) Proceedings of the VIth Asian-Pacific Symposium on Cardiac Pacing and Electrophysiology, Bologna, Italy, Monduzzi Editore S.p.A., 1997; 61–64.
Limousin M, Gerous L, Nitzsche R, et al., Value of automatic processing and reliability of stored data in an implanted pacemaker, initial results in 59 patients, PACE 1997; 20: 2893–2898.
Machado C, Johnson D, Thacker JR, Duncan JL, Pacemaker patient-triggered event recordings, accuracy, utility and cost for the pacemaker follow-up clinic, PACE 1996; 19: 1813–1818.
Ohm OJ, Breivik K, Hammer EA, Hoff PI, Intraoperative electrical measurements during pacemaker implantation, Clin Prog Pacing Electrophysiol 1984; 2: 1–23.
Bernstein AD, Parsonnet V, Implications of constant-energy pacing, PACE 1983; 6: 1229–1233.
Irnich W, The chronaxie time and its practical importance, PACE 1980; 3: 292–301.
Stokes K, Bornzin G, The electrode-biointerface: Stimulation. In Barold SS (ed), Modern Cardiac Pacing. Armonk NY, Futura Publishing Co, 1985; 33–77.
Levine PA, Confirmation of atrial capture and determination of atrial capture thresholds in DDD pacing systems, Clin Prog Pacing Electrophysiol 1984; 2: 465–473.
Sowton E, Barr I, Physiologic changes in threshold, Ann NY Acad Sci, 1969; 167: 679–685.
Preston TA, Fletcher RD, Lucchesi BR, Judge RD, Changes in myocardial threshold. Physiologic and pharmacologic factors in patients with implanted pacemakers, Am Heart J 1967; 74: 235–242.
Hayes DL, Effect of drugs and devices on permanent pacemakers, CARDIO 1991; 8: 70–75 (January).
Danilovic D, Ohm OH, Pacing threshold trends and variability in modern tined leads assessed using high resolution automatic measurements, conversion of pulse width into voltage thresholds, PACE 1999; 22: 567–587.
Syed J, Lau C, Nishimura S, Circadian and unexpected changes in stimulation threshold, PACE 1999; 22: 757.
Schuchert A, van Langen H, Michels K, et al., Present day pacemakers for pulse generator exchange: Is 3.5 Volts a sufficient nominal setting for the pulse amplitude? PACE 1996; 1824–1827.
Marco D, Pacemaker output settings for lowest current drain and maximum longevity, Reblampa 1995; 8: 159–162.
Crossley GH, Gayle D, Simmons TW, et al., Reprogramming pacemakers enhances longevity and is cost-effective, Circulation 1996; 94 (Suppl II): 245–247.
Furman S, Hurzeler P, de Caprio V, Cardiac pacing and pacemakers III. Sensing the cardiac electrogram, Am Heart J 1977; 93: 794–801.
Clarke M, Liu B, Schuller H, et al., Automatic adjustment of pacemaker stimulation output correlated with continuously monitored capture thresholds, a multicenter study, PACE 1998; 21: 1567–1575.
Cameron DA, Hale C, Cusimano RJ, et al., Dual chamber ventricular AutoCapture device, an initial experience, PACE 1999; 22: 854.
Nowak B, Kampmann C, Schmid FX, et al., Pacemaker therapy in premature children with high degree AV block, PACE 1998; 21: 2695–2698.
Breivik K, Ohm OJ, Engedal H, Long term comparison of unipolar and bipolar pacing and sensing using a new multiprogrammable pacemaker system, PACE 1983; 6: 592–600.
Ohm OJ, Demand failures occurring during permanent pacing in patients with serious heart disease, PACE 1980; 3: 44–55.
Griffin JC, Finke WL, Analysis of the endocardial electrogram morphology of isolated ventricular beats, PACE 1983; 6: 315.
Bricker JT, Ward KA, Zinner A, Gillette PC, Decrease in canine endocardial and epicardial electrogram voltage with exercise: Implications for pacemaker sensing, PACE 1988; 11: 460–464.
Frohlig G, Schwerdt H, Schieffer H, et al., Atrial signal variations and pacemaker malsensing during exercise: A study in the time and frequency domain, J Am Coll Cardiol 1988; 11: 806–813.
Levine PA, Podrid PJ, Klein MD, Keefe J, Selznick L, Pacemaker sensing: Comparison of signal amplitudes determined by electrogram telemetry and noninvasively measured sensing thresholds, PACE 1989; 12: 1294.
Palma EC, Kedarnath V, Vankawalla V, et al., Effect of varying atrial sensitivity, AV interval, and detection algorithm on automatic mode switching, PACE 1996; 19: 1734–1739.
Brandt J, Fahraeus T, Schuller H, Far-field QRS complex sensing via the atrial pacemaker lead, I: Mechanism, consequences, differential diagnosis and countermeasures in AAI and VDD/DDD pacing, PACE 1988; 11: 1432–1438.
Secemsky SI, Hauser RG, Denes P, Edwards LM, Unipolar sensing abnormalities: incidence and clinical significance of skeletal muscle interference and undersensing in 228 patients, PACE 1982; 5: 10–19.
Levine PA, Caplan CH, Klein MD, Brodsky SJ, Ryan TJ, Myopotential inhibition of unipolar lithium pacemakers, Chest 1982; 82: 461–465.
Gross JN, Platt S, Ritacco R, Andrews C, Furman S, The clinical relevance of electromyopotential oversensing in current unipolar devices, PACE 1992; 15: 2023–2027.
Technical Information Report–Systems used to forecast remaining pacemaker battery service life, Washington, DC, Association for the Advancement of Medical Instrumentation, 1998, Document # AAMI TIR No. 21–1998.
Jacobs DM, Fink AS, Miller RP, et al., Anatomical and morphological evaluation of pacemaker lead compression, PACE 1993; 16: 434–444.
Magney JE, Flynn DM, Parsons JA, et al., Anatomical mechanisms explaining damage to pacemaker leads, defibrillator leads and failure of central venous catheters adjacent to the sternoclavicular junction, PACE 1993; 16: 445–457.
Antonelli D, Rosenfeld T, Freedberg NA, et al., Insulation lead failure: Is it a matter of insulation coating, venous approach or both? PACE 1998; 21: 418–421.
Ben Zur UM, Platt SB, Gross JN, et al., Direct and telemetered lead impedance PACE 1994; 17: 2004–2007.
Danilovic D, Ohm OJ, Pacing impedance variability in tined steroid eluting leads, PACE 1998; 21: 1356–1363.
Sharif MN, Wyse DG, Rothschild JM Gillis AM, Changes in lead impedance over time predict lead failure, Am J Cardiol 1998; 82: 600–603.
Siegmund JB, Wilson JH, Lattner SE, et al., Impedance of pacemaker leads: Correlation of different methods, PACE 1996; 19: 90–94.
Furman S, Pacemaker follow-up in Furman S, Hayes D, Holmes D (eds) A Practice of Cardiac Pacing. Armonk NY, Futura Publishing Company 1993; 571–603.
Vincent JA, Cavitt DL, Karpawich PP, Diagnostic and cost-effectiveness of telemonitoring the pediatric pacemaker patient, Pediatric Cardiol 1997; 18: 86–90.
Dreifus LS, Zinberg A, Hurzeler P, et al., Transtelephonic monitoring of 25, 919 implanted pacemakers, PACE 1986; 9: 371–378.
Greendahl H, Pacemaker follow-up with prolonged intervals in the stable period of 1 to 5 years postimplant, PACE 1996; 19: 1219–1224.
Sweeesy MW, Erickson SL, Grago JA, et al., Analysis of the effectiveness of in-office and transtelephonic follow-up in terms of pacemaker system complications, PACE 1994; 17: 2001–2003.
Levine PA, Electrocardiography of bipolar single and dual-chamber pacing systems, Herzschrittmacher 1988; 8: 86–90.
Lesh MD, Langberg JJ, Griffin JC, et al., Pacemaker generator pseudomalfunction: an artifact of Holter monitoring, PACE 1991; 14: 854–857.
Van Gelder LM, Bracke FALE, El Gamal MIH, Fusion or confusion on Holter recordings, PACE 1991; 14: 760–763.
Engler RL, Goldberger AL, Bhargava V, Kapelusznik D, Pacemaker spike alternans: An artrifact of digital signal processing, PACE 1982; 5: 748–750.
Slack JP, Identification of recording artifact in a dual chamber (DDD) paced rhythm, clues from the electrocardiogram, Clin Prog Pacing Electrophysiol 1984; 2: 384–387.
Levine PA, Pacemaker pseudo-malfunction, PACE 1981; 4: 563–565.
Levine PA, Selznick L, Prospective management of the patient with retrograde ventriculo-atrial conduction, prevention and management of pacemaker mediated endless loop tachycardias. Sylmar, CA, Pacesetter, Inc., 1990.
Limousin M, Bonnet JL, A multi-centric study of 1816 endless loop tachycardia (ELT) responses, PACE 1990; 13: 555.
Oseran D, Ausubel K, Klementowicz P, et al., Spontaneous endless loop tachycardia, PACE 1986; 9: 379–381.
Levine PA, Postventricular atrial refractory periods and pacemaker mediated tachycardias, Clin Prog Pacing Electrophysiol 1983; 1: 394–401.
Famularo MA, Kennedy HL, Ambulatory electrocardiography in the assessment of pacemaker function, Am Heart J 1982; 104: 1086–1094.
Saksena S, Clinical practice patterns in implantable rhythm management device therapy: New players and new norms, PACE 1999; 22: 814–815.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Levine, P.A., Isaeff, D.M. (2008). Follow-up Management of the Paced Patient. In: Kusumoto, F.M., Goldschlager, N.F. (eds) Cardiac Pacing for the Clinician. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-72763-9_19
Download citation
DOI: https://doi.org/10.1007/978-0-387-72763-9_19
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-72762-2
Online ISBN: 978-0-387-72763-9
eBook Packages: MedicineMedicine (R0)