Follow-up of implanted pacemakers: invasive versus non-invasive testing

This study is the first detailed report of permanent pacing in 120 pts. Carried out in Cairo University hospitals through the experience of the critical care center over the past five years. During the latter period, 120 permanent PM belonging to various manufactures were permanently implanted. Implantation was endocardial in 114 pts. Via the subclavian puncture carried out by the cardiologist, and epicardial [6 pts.] conducted by a cardiac surgeon. PM implanted were of the simple VVi type in 110 pts. multiprogrammable in 10. This study showed that the overall number of implanted PM [120 over five years] is still far below the number of implantations in other centers. However, the increasing yearly distribution reflects the increasing referral of pts. And the increasing availability of PM. The routine use of EPS served to exclude loose indications for implantation and might be behind the relatively low number of pts. with PM. The study also showed that symptomatic bradyarrhythmia due to various types of AV block was the prime indication for pacing in our group of pts. Out of 120 pts. Subjected to PM implantation, 92 were followed-up in our PM clinic at an average period of 26 months. Methods of assessment included resting and dynamic ECG, magnet testing, electronic testing, chest wall stimulation, fluoroscopy, beside careful thorough clinical examination. Our system of follow-up seemed to be adequate concerning the early detection of different PM system abnormalities, and showed that non-invasive route remains mandatory to identify the underlying etiology. The latter was carried out at the time of reoperation, exposure and use of pacing system analyzer

Follow up of implanted pacemakers generator versus lead malfunction

The incidence of PM problems whether due to generator or lead malfunctions varied widely and was related to the generator and electrode characteristics, underlying cardiovascular disorder and the experience of the implanting physician. The time factor had also an important role, in so far as lead problems tend to occur during the early post-implantation period and battery depletion shows itself later on. In the group included in our study, pacemaker problems due to lead defects were 3-4 times more frequent than those due to generator depletion. Twelve pacemaker problems were encountered in 22 patients and were divided into three generator problems in six patients, four lead problems in seven patients. Two patients suffered pacemaker side effects and the remaining two had pseudomalfunctions. Generator problems included power source depletion. Oversensing, and altered programmabilty. Lead problems encountered were lead mal- position, wire break, insulation defect, and set screw unfitness. While problems related to the myocardium included exit block and undersensing of small ORS complexes. Correction of PM problems could be conducted in the majority of cases either through reprogramming of programmable PM, or reexposure in cases of generator problems or lead malposition. The above mentioned study illustrates a number of other important facts: the relatively lower rate of permanent PM implantation in comparison other centers, and the usefulness of non- invasive methods of follow-up in the majority of cases. Although follow-up is much easier and correction of malfunction is more attainable through the use of programmable PMS, it is felt that VVI PMS could still satisfy the needs both patients and physicians in our society