ABSTRACT
We have developed computer hardware and software that imports analog waveforms and other measured data from a patient into the PaceBase database system supported by any IBM PC/AT compatible. The programmable A/D converter has the capacity to acquire the pacemaker artifact from the surface ECG leads. Analysis of the pacemaker artifact permits confirmation of pulse width as well as programmability and facilitates discovery of pacemaker hardware failures otherwise undetectable. Continuous recording of real-time surface ECG can be made as other measurements or storing functions are being performed. In this way, sporadic or infrequent intrinsic events are automatically recorded and can be selected to be played back and reviewed or stored on the permanent record. Pacemaker spike detection enhances identification of paced and intrinsic complexes by emphasizing the paced artifact. Even bipolar atrial spikes with pulse widths as short as 0.05 ms are easily identified; myopotential muscle noise is rejected. Enhancement of pacemaker spikes takes the guesswork out of interpretation of ECGs, especially for bipolar systems and when testing or troubleshooting for myopotential tracking or inhibition.
Subject(s)
Computer Systems , Electrocardiography , Pacemaker, Artificial , Analog-Digital Conversion , Equipment Design , Humans , Information Storage and Retrieval , Software , Time FactorsABSTRACT
A 44-month retrospective analysis was performed on 666 pacemakers implanted at Mt. Sinai Medical Center. Mapping techniques and endocardial waveform analyses were used during lead positioning to ensure the best electrical environment. The optimal pacing lead type was selected based on the clinical situation. Follow-up evaluations were rigorous. Patient population ranged in age from 28 to 103 with a mean of 78 years at time of implant. Seventy percent of the patients received DDD pacemakers with an 81% survival incidence at 44 months. Of the VVI population (30% of the implants), there was a 62% survival incidence. Most problems associated with the pacing systems were related to the atrial channel. Loss of atrial sensing occurred in 7.5% of the population and was corrected noninvasively in 5.8%. Due to chronic loss of atrial sensing, 1.7% of the population remained programmed to DVI/VVI. A total of 7.7% were chronically reprogrammed from DDD to VVI, 5.6% secondary to atrial fibrillation. Reoperations were necessary in 1.2% of the malfunctioning systems that could not be corrected by reprogramming. The following conclusions were reached: (1) maximizing hemodynamic benefits and minimizing pacemaker complications permitted a survival rate equal to or better than that of the general population, and (2) chronic problems related to the atrial lead and malfunctions of the pacing system were minimized by careful patient selection, appropriate pacemaker and lead selection, endocardial waveform analysis, and thorough follow-up.
Subject(s)
Hemodynamics , Pacemaker, Artificial , Adult , Aged , Aged, 80 and over , Cardiac Pacing, Artificial/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pacemaker, Artificial/adverse effects , Retrospective Studies , Time FactorsABSTRACT
We have developed a computer program which simulates a paced cardiac rhythm strip, graphically generating the electrocardiogram (ECG) on a color monitor. Any pacemaker, programmed as desired, dynamically interacts with a preselected intrinsic rhythm. Utilizing symbols prevalent in the pacing industry, this graphics-oriented, interactive system promotes a rapid understanding of pacemaker function by automatically superimposing specific pacemaker events on a rhythm strip. These events include: pacemaker spikes, evoked cardiac depolarization waveforms, refractory periods, upper rate intervals, and blanking periods. Applications of this program include interpreting and verifying appropriate pacemaker function, demonstrating idiosyncrasies of the various pacemakers, and teaching.
Subject(s)
Computer Graphics , Computer Simulation , Electrocardiography , Models, Cardiovascular , Pacemaker, Artificial , HumansABSTRACT
The pacemaker center evaluation was responsible for the timely reoperation of 341 pacemaker patients over the last three years. The most common indication for reoperation was battery end-of-service (46.3%). Battery testing and maintenance of accurate records for trend analysis ensures prompt generator replacement. Atrial and/or ventricular lead malfunction was the second largest indication (26.3%). Lead malfunction detected by bracketing capture and sensing thresholds included: dislodgement, penetration, exit block, fracture, insulation failure, and abnormal sensing. The third largest indication for reoperation was pacemaker pocket erosion and/or infection (15.5%). Examination of the pacemaker pocket site is an integral part of an evaluation. In conclusion, the three largest indications for reoperations can be best demonstrated in a pacemaker center where evaluations are personal and thorough, and accurate record keeping is maintained.
Subject(s)
Pacemaker, Artificial/adverse effects , Adult , Aged , Aged, 80 and over , Electrocardiography , Electrodes, Implanted , Equipment Failure , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Monitoring, Physiologic , ReoperationABSTRACT
The automated studies performed at implant require little extra time and provide essential information for postoperative troubleshooting and patient management. The automated testing and analysis system is but one component in a comprehensive patient management system designed for and dedicated to pacing; the system is an integral part of a complete data management system which includes extensive follow-up and management sections.
