Objectives - We sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes' in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups. This aspect has not been widely discussed so far. Methods and results - Ambulatory 24-hour Holter recordings [HM] were performed in 100 patients with DDD pacemakers one day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances. Despite proper sensing and pacing parameters, HM revealed PM disturbances in 23% of the patients. Atrial undersensing episodes were found in 12 patients and failure to capture in I patient. T wave oversensing was the most common ventricular channel disorder (9 patients). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found. Conclusion - Asymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation.Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogramme PM parameters.

Pacing and sensing disturbances in patients with DDD pacemakers in the early period after implantation.

Summary The ideal pacing lead remains an elusive goal. The controversy about the ideal pacing lead polarity has continued for many years with respect to which system is the superior: unipolar or bipolar. The aim of our study was to compare unipolar and bipolar leads implanted in VVI patients by estimating the incidence of pacing and sensing dysfunction episodes in 24-hour ECG Holter recordings. Retrospective analysis of Holter recordings was performed for two patient groups: Group UP consisted of 130 patients with VVI pacemakers and unipolar leads, implanted in 1993 – 1995, while group BP consisted of 130 patients with VVI pacemakers and bipolar leads implanted in 1998 – 2000. In all these patients, 24-hour Holter monitoring was performed 3 – 24 months after pacemaker implantation in order to evaluate oversensing and undersensing as well as pacing disturbances. In patients with unipolar leads, the most frequently observed disturbances were oversensing events, caused by myopotential detection. Holter monitoring showed pauses of up to 1150 – 2600 ms, which appeared at various times of the day. The second most common disturbances were undersensing episodes, which were noted in six patients. Ineffective pacing was also observed, accompanied by pauses from 1200 ms up to 3800 ms and without hemodynamic consequences. In two patients, pauses were caused by exit block, and in another two patients by lead fracture. A new lead was implanted in all four patients. In the group of patients with bipolar leads, sensing disturbances occurred in only two patients: one experienced oversensing with a pause of 1300 ms, and the other had an episode of undersensing. In patients with a VVI pacemaker, implantation of bipolar leads was associated with a significantly decreased incidence of under- and oversensing compared to implantation of unipolar leads. Progress in endocardial lead technology reduces the risk of loss of capture in VVI patients.

From Unipolar to Bipolar Leads: Fewer Problems, More Advantages?

Background : Twenty four hour Holter monitoring (HM) in an early post-implantation
period in asymptomatic patients is considered as class IIb according to the ACC/AHA guidelines.
It seems that post-implantation assessment extended by 24 hour HM in these patients
might shorten hospitalization and increase safety of these patients. This aspect has not been
widely discussed so far. The aim of our study was to evaluate pacing and sensing disturbances
in asymptomatic patients with proper parameters of single and double chamber pacemakers. 
Methods : Studied group included 236 patients implanted with Biotronik Actros S (single
chamber) (group I - 130 patients) and Biotronik Actros D or Axios D (group II - 106 patients)
pacemakers. In all the patients 24 hour HM was performed 1-6 days after implantation (mean 3.4)
in order to assess all pacing and sensing disturbances. 
Results : Sensing disturbances were found in 2 patients from group I and 22 patients from
group II (the most frequent pacemaker failure was atrial undersensing followed by ventricular
oversensing-T wave stering). In 1 patient from group I atrial failure to pace was observed. In
whole group pacing/sensing disturbances were found in 23% of patients, nevertheless they did
not provoke any hemodynamic consequences. 
Conclusions : In an early post-implantation period pacemaker disturbances occur in 23% of
asymptomatic patients being more frequent in patients with dual chamber pacemaker. Atrial
undersensing and ventricular oversensing are the most common disturbances, nevertheless
having no hemodynamic consequences they are not life-threatening. Detection of these episodes
in an early post-implantation period allows for early change in pacemakers’ parameters and
thus decreasing risk of rehospitalization. We confirmed the low usefulness of HM in patients
with single chamber pacemaker early after implantation.

/pdf/the-usefulness-of-24-hour-holter-monitoring-in-asymptomatic-4unvej6bwp.pdf

The usefulness of 24 hour Holter monitoring in asymptomatic pacemaker patients in early post-implantation period

Background: The cost of a pacemaker (PM) system increases with its degree of complexity and sophistication. We are forced to reduce the costs of the treatment of our patients. One of the method which can lead to this, is to shorten the duration of hospitalization in cardiological refernce center. Although marked development of PM and lead technology in the last years was achieved still, the potential risk for pacemaker implanted patient must be considered. That is why we decide to estimate the safety of pacemaker implantation in patients with 24 hour hospitalization. The aim of the study was to assess the safety of 24 hour hospitalization in reference center after dual chamber PM (DDD PM) implantation. Material and methods: Prospective analyze of 80 patients with DDD PM was performed. Patients were devided into two groups: group I — 42 patients with long term hospitalisation in reference center (RC), group II — 38 patients with 24 hour hospitalisation in RC. Following electrical and clinical parameters were compared between two groups on the 1 st day (1 dFU) and 3 months (3 mFU) after implantation: atrial and ventricle pacing threshold, P and R wave amplitude, lead impedance, lead dislodgment, pocket haematoma, pneumothorax. Additionally Holter recordings in all patients in 1 dFU and 3 mFU was performed to estimate: all PM disturbances (PD), failure to pace (FP), failure to sense (FS). Failure to sense were divided to over (FSO) and undersensing (FSU) episodes. Results: All electrical parameters during 1 dFU and 3 mFU were satisfactory and there were no significant differences between two groups. There was any incidence of lead dislodgment, pocket haematoma, pneumothorax noted within 24 hours after implantaion and at 3 months FU.

/pdf/czy-mozliwe-jest-bezpieczne-skrocenie-czasu-hospitalizacji-40d5gxlro9.pdf

Czy możliwe jest bezpieczne skrócenie czasu hospitalizacji pacjentów po zabiegu implantacji stymulatora dwujamowego serca w ośrodku wysoko specjalistycznym? Can we discharge patients from a reference center 24 hours after dual chamber pacemaker implantation?

Wstep : Wedlug standardow AHA/ACC u pacjentow bez objawow we wczesnym okresie po
implantacji stymulatora serca wykonywanie 24-godzinnego EKG metodą Holtera znajduje sie
w klasie zalecen IIb. Wydaje sie, ze rozszerzenie rutynowej kontroli pacjentow we wczesnym
okresie po implantacji o 24-godzinne EKG metodą Holtera moze stanowic czynnik skracający
czas hospitalizacji oraz zwiekszający bezpieczenstwo tych chorych. Tego zagadnienia nie omowiono
jeszcze w dostepnym piśmiennictwie. Celem pracy byla ocena zaburzen stymulacji i sterowania
w 24-godzinnym EKG metodą Holtera we wczesnym okresie pooperacyjnym u chorych bez
objawow z prawidlowymi parametrami implantowanych stymulatorow jedno- i dwujamowych. 
Metody : Do badania wlączono wstepnie 236 osob z implantowanym stymulatorem jednojamowym
Actros S (Biotronik) (grupa I - 130 pacjentow) lub stymulatorem dwujamowym
Actros D(R) lub Axios D(R) (grupa II - 106 osob). U wszystkich chorych w okresie 1–6 dni
(śr. 3,4 ± 1,2 dnia) po implantacji wykonywano 24-godzinne EKG metodą Holtera (Oxford
Medilog Excel 3), oceniając w kazdej z grup zaburzenia stymulacji i sterowania.
 Wyniki : Zaburzenia wyczuwania stwierdzono u 2 pacjentow z grupy I i u 22 chorych z grupy II
(najczestszym zaburzeniem byl undersensing elektrody przedsionkowej, a nastepnie oversensing
elektrody komorowej - sterowanie zalamkiem T). U 1 pacjenta z grupy II stwierdzono zaburzenia
stymulacji elektrody przedsionkowej. Łącznie w calej grupie zaburzenia stymulacji/wyczuwania odnotowano
u 23% osob, jednak u zadnej z nich nie powodowaly one nastepstw hemodynamicznych. 
Wnioski : Zaburzenia pracy stymulatora we wczesnym okresie po implantacji wystepowaly u 23%
chorych bez objawow i są czestsze u pacjentow ze stymulatorami dwujamowymi. Undersensing
elektrody przedsionkowej i oversensing elektrody komorowej są najcześciej stwierdzanymi nieprawidlowościami,
jednak nie stanowią one zagrozenia dla zycia pacjentow. Wykrycie tych zaburzen
we wczesnym okresie pozwala na zmiane parametrow stymulatora i unikniecie kolejnej hospitalizacji.
Potwierdzono jednocześnie znikomą wartośc 24-godzinnego EKG metodą Holtera u pacjentow
ze stymulatorami jednojamowymi.

/pdf/przydatnosc-wykonywania-24-godzinnego-ekg-metoda-holtera-u-1ymevfxnso.pdf

Przydatność wykonywania 24-godzinnego EKG metodą Holtera u pacjentów bez objawów we wczesnym okresie po implantacji stymulatora

24-hour ECG Holter monitoring - detection of asymptomatic stimulationdisturbances in patients with artificial pacemakers

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24-hour ECG Holter monitoring - detection of asymptomatic stimulationdisturbances in patients with artificial pacemakers