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Europace 2002 4(1):55-59; doi:10.1053/eupc.2001.0210
© 2002 by European Society of Cardiology
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PACING

Pacemaker troubleshooting: improved efficacy using a new diagnostic digital Holter recording system

J. P. Moak, B. Gunderson1, V. Freedenberg and C. Ramwell

Department of Cardiology, Children's National Medical Centre Washington, DC, U.S.A.; 1Medtronic Inc, Fridley Minnesota, U.S.A.

Asymptomatic dysfunction of cardiac pacing systems is not uncommonly detected using long-term ambulatory monitoring techniques. We report two patients with atrial and ventricular sensing abnormalities noted only on Holter monitoring. Multiple empirical attempts at pacemaker reprogramming based on deductive analysis of the pacing anomaly were unsuccessful. Through the use of a new digital recording system that allowed collection of surface electrocardiographic data, intracardiac electrograms, and Marker ChannelTM data a correct diagnosis was made (pacing lead insulation failure). This new recording system has the advantage of significantly improving diagnostic sensitivity and resulting in cost savings.

Key Words: Pacemaker troubleshooting, sensing abnormalities, Holter monitoring, pacing lead fracture

Correspondence: Dr Jeffrey P. Moak, Department of Cardiology, Children's National Medical Centre, Washington, DC 20010, U.S.A. E-mail: jmoak{at}CNMC.org

[1] Brandes A, Bethge KP, Gonska BD, Diederich KW. Transient pacemaker dysfunction and spontaneous arrhythmias in symptomatic and asymptomatic patients with demand pacemakers. Z Kardiol 1996; 85: 237–247.[Medline]

[2] Secemsky SI, Hauser RG, Denes P, Edwards LM. Unipolar sensing abnormalities: incidence and clinical significance of skeletal muscle interference and undersensing in 228 patients. Pacing Clin Electrophysiol 1982; 5: 10–19.[Medline]

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[4] Gillis AM, Hillier KR, Rothschild JM, McDonald M, Simpson CA, Wyse DG. Ambulatory electrocardiography for the detection of pacemaker lead failure. Pacing Clin Electrophysiol 1997; 20: 1274–1282.[Medline]

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[7] Kelen GJ, Bloomfield DA, Hardage M, et al. A clinical evaluation of an improved Holter monitoring technique for artificial pacemaker function. Pacing Clin Electrophysiol 1980; 3: 192–197.[Medline]

[8] Nowak B, Middeldorf T, Housworth CM, et al. Holter recordings with continuous marker annotations: a new tool in pacemaker diagnostics. Pacing Clin Electrophysiol 1996; 19: 1791–1795.[CrossRef][Medline]


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This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
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Right arrow Articles by Moak, J. P.
Right arrow Articles by Ramwell, C.
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