Myopotential interference with DDD pacemakers: Endocardial electrographic telemetry in the diagnosis of pacemaker-related arrhythmias

Jonathan L. Halperin, Jorge L. Camuñas, Eric H. Stern, Elizabeth B. Rothlauf, Joel Kupersmith, Manuel R. Estioko, Robert C. Mace, Marilyn Y. Steinmetz, Louis E. Teichholz

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Skeletal myopotentials may inhibit the output of unipolar demand ventricular pacemakers, resulting in protracted episodes of asystole in susceptible patients. The new DDD-mode pacemakers have, in addition to a unipolar ventricular lead, a unipolar atrial lead to enable atrioventricular sequential or atrial synchronous function. During clinical investigation of a new dual-unipolar cardiac pacing system programmed to operate in the DDD mode (Pace-setter AFP models 281 and 283), 6 patients were noted (5 men and 1 woman, aged 22 to 68 years) who manifested paroxysmal acceleration of ventricular pacing rate approaching the maximal tracking rate. Two patients also had abrupt slowing or cessation of ventricular output. With the use of atrial electrographic recordings (obtained with telemetry), the following mechanisms of rate change were found: myopotential tracking, myopotential inhibition, interference-mode asynchronous operation, sudden increases in sinus rate, and pacemaker-mediated reentrant tachycardia. In all patients, reprogramming of the implanted devices, based on telemetered atrial electrography, resulted in disappearance of the arrhythmias and loss of symptoms while maintaining the DDD pacing mode. Thus, several mechanisms of rhythm disturbances are peculiar to dual-chamber cardiac pacing systems that use unipolar electrodes. Endocardial telemetry combined with extensive programming capability offers the best opportunity for proper diagnosis and management of these problems.

Original languageEnglish
Pages (from-to)97-102
Number of pages6
JournalAmerican Journal of Cardiology
Volume54
Issue number1
DOIs
StatePublished - 1 Jul 1984

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