Key result
Adjusting the post-stimulus pulse duration of a tri-phasic stimulation pulse achieved successful pace polarization artefact reduction in 97.8% of ventricular leads and 98.7% of atrial leads.
Why the study?
Does adjusting the post-stimulus pulse duration of a tri-phasic stimulation pulse reduce pace polarization artefacts in patients with implanted pacemakers?
Does adjusting the post-stimulus pulse duration of a tri-phasic stimulation pulse reduce pace polarization artefacts in patients with implanted pacemakers?
Adjusting a tri-phasic stimulation pulse effectively reduces pace polarization artefacts and allows reliable ventricular capture detection, though atrial capture detection remains problematic due to false positives.
May aid ventricular capture detection; atrial false positives leave routine adoption open pending validation.
This study investigated the ability to minimize pace polarization artefacts (PPA) by adjusting the post-stimulus pulse duration of a tri-phasic stimulation pulse. Adjustment of the stimulation pulse was enabled by downloading special study software into an already implanted pacemaker. Tests were performed in a total of 296 atrial leads and 311 ventricular leads. Both chronic and acute leads were included in the study. Statistically significant differences were found in the initial PPA (without any adjustment of the stimulus pulse) between atrial and ventricular leads. In addition, significant differences were observed among various lead models with respect to changes over time in the initial ventricular PPA. Successful PPA reduction was defined as a reduction of the PPA below 0.5 mV for atrial leads and below 1 mV for ventricular leads. Results show a success rate for ventricular and atrial PPA reduction of 97.8% and 98.7%, respectively. Threshold tests showed that after reduction of the PPA loss of ventricular capture can be reliably detected. However, atrial threshold tests showed many false positive evoked response detections. In addition, unexpectedly high evoked response amplitudes were observed in the atrium after reduction of the PPA. Results from additional measurements suggest that these high atrial evoked response amplitudes come from the influence of the input filter of the pacemaker.
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Sutton et al. (2004) studied Pacemaker implantation. Adjustment of the post-stimulus pulse duration of a tri-phasic stimulation pulse vs. Initial pace polarization artefact (without adjustment) was evaluated on Successful pace polarization artefact (PPA) reduction (below 0.5 mV for atrial leads and below 1 mV for ventricular leads). Adjusting the post-stimulus pulse duration of a tri-phasic stimulation pulse achieved successful pace polarization artefact reduction in 97.8% of ventricular leads and 98.7% of atrial leads.
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