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Nagamoto Y, Shiomi T, Matsuura T, Okahara A, Inoue K, Yamaguchi R, Takegami K, Mine D, Shirahama T, Koga Y, Yoshida K, Sadamatsu K, Hayashida K. Ventricular pacing inhibition by oversensing due to diaphragmatic myopotential during deep inspiration. J Cardiol Cases 2013; 8:e81-e84. [PMID: 30546749 DOI: 10.1016/j.jccase.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/17/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022] Open
Abstract
An 80-year-old man, who had dilated cardiomyopathy with right ventricular (RV) dilatation, underwent implantable cardioverter defibrillator (ICD) implantation for advanced atrioventricular block and primary prevention of sudden cardiac death. Tined and screw-in leads were placed on the right atrial appendage and RV apex, respectively. Ventricular pacing inhibition was detected after surgery due to oversensing by diaphragmatic myopotential occurring only during deep inspiration. We performed re-surgery and switched the screw-in lead for a tined lead. The diaphragmatic myopotential decreased, thereby improving oversensing by diaphragmatic myopotential and ventricular pacing inhibition. It might be beneficial to use a tined lead when placing the ventricular lead at the RV apex for implantation of a pacemaker or ICD if oversensing of diaphragmatic myopotential is observed using a screw-in lead. <Learning objective: Oversensing due to diaphragmatic myopotential is rarely observed. However if it occurs, it becomes a critical problem, which causes pacemaker inhibition or inappropriate ICD shock. However, the method of preventing this problem is unknown. In this case, we demonstrated that a tined-lead may be useful for the prevention of oversensing by diaphragmatic myopotential.>.
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Affiliation(s)
- Yasutsugu Nagamoto
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Tetsuya Shiomi
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Taku Matsuura
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Arihide Okahara
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Kota Inoue
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Rika Yamaguchi
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Kaoru Takegami
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Daigo Mine
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Takaharu Shirahama
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Yasuaki Koga
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Keiki Yoshida
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Kenji Sadamatsu
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
| | - Kiyoshi Hayashida
- Division of Cardiology, Saga Prefectural Hospital Koseikan, 1-12-9 Mizugae, Saga 840-8571, Japan
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Santos KR, Adragao P, Cavaco D, Morgado FB, Candeias R, Lima S, Silva JA. Diaphragmatic myopotential oversensing in pacemaker-dependent patients with CRT-D devices. Europace 2008; 10:1381-6. [DOI: 10.1093/europace/eun241] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Deshmukh P, Anderson K. Myopotential sensing by a dual chamber implantable cardioverter defibrillator: two case reports. J Cardiovasc Electrophysiol 1998; 9:767-72. [PMID: 9684725 DOI: 10.1111/j.1540-8167.1998.tb00964.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Inappropriate discharges and/or improper inhibition of bradycardia pacing due to oversensing of extraneous signals in implantable cardioverter defibrillators (ICDs) have been described. With one exception, no previous report involving an intact lead system has cited myopotential oversensing as the cause. METHODS AND RESULTS Two case reports of myopotential oversensing by a dual chamber ICD system are reported. In the first patient suffering from chronic pulmonary obstructive disease, intermittent myopotential sensing during labored respiration resulted in episodic inhibition of bradycardia pacing. In the second patient, oversensing of sustained myopotentials generated during strenuous isometric activity resulted in an inappropriate ICD discharge. For both, the ICD system consisted of a CPI model 1810 Ventak AV used in conjunction with a model 0125 Endotak lead, incorporating integrated bipolar sensing. CONCLUSION Although modern ICDs have proven to be highly effective in detecting and terminating malignant tachyarrhythmias, the opportunity for improving their detection specificity remains.
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Affiliation(s)
- P Deshmukh
- Cardiology Division, Robert Packer Hospital, Sayre, Pennsylvania 18840, USA
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Abstract
An 81-year-old man was treated for high degree AV block and syncope with an AV universal (DDD) pacemaker. Bipolar active fixation atrial and ventricular leads were used. Intermittent oversensing from the ventricular lead was detected on Holter monitoring following implantation. This resulted in inappropriate inhibition of ventricular pacing. Ventricular electrogram showed spurious signals between 5 mV and 15 mV in magnitude coincident with ventricular lead inhibition. Treatment consisted of reprogramming the device to the VVT mode. Six weeks after implantation normal pacemaker function in the DDD mode was demonstrated on Holter monitoring and inappropriate pacer inhibition could not be demonstrated. We postulate that electrode 'chatter' between the cathodal ring electrode and the helix of the ventricular lead resulted in artifactual potentials sufficient to inhibit pacing. We hypothesize that fibrosis and fixation of the ventricular lead tip over a period of weeks eliminated these electromechanical artifacts and resulted in the oversensing problem being self-limited. Physicians should be aware of electrode 'chatter' as a cause of pacemaker oversensing.
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Affiliation(s)
- P H Chew
- Division of Cardiology, Francis Scott Key Medical Center, Baltimore, MD 21224
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7
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Keung EC, Sudduth B. Arrhythmias in Single-Chamber Pacemakers. Cardiol Clin 1985. [DOI: 10.1016/s0733-8651(18)30652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Levine PA, Caplan CH, Klein MD, Brodsky SJ, Ryan TJ. Myopotential inhibition of unipolar lithium pacemakers. Chest 1982; 82:461-5. [PMID: 7116965 DOI: 10.1378/chest.82.4.461] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The effect of isometric upper extremity exercise on pacemaker function was evaluated in 27 patients who remained pacemaker-dependent during testing. Inhibition was demonstrated in eight (31 percent) of which five were symptomatic. Based on design of the sensing amplifier and return to an all-metal housing in the unipolar lithium pulse generators, myopotential inhibition is being recognized as one cause of symptomatic pacemaker inhibition that is more common than generally appreciated. A method of evaluation and management options for symptomatic patients are discussed. Routine testing of all patients should be performed at the time of a regular office evaluation. If one model pulse generator appears to be particularly prone to myopotential inhibition, this knowledge should be considered in the choice of future pacing systems.
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Widmann WD, Edoga JK, Thomas L, Palmer P, Muccione S. Inhibition of programmable demand pacemaker by pacemaker-induced myopotentials. Chest 1981; 80:328-31. [PMID: 7273884 DOI: 10.1378/chest.80.3.328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Pacemaker-induced myopotentials caused inhibition of a demand pacemaker in two cases in which the unipolar partially encapsulated pacemaker flipped over in its pocket and directly stimulated the muscles of the chest wall. This pacemaker-induced muscular stimulation, possibly combined with afterpotential sensing or T-wave sensing (or both), caused the rate of the demand pacemaker to fall when the output of the programmable pacemaker was set to deliver high energy charges. By programming the unit to deliver a lower charge (shorter width of pulse), the rate rose appropriately to the programmed rate. Likewise, manual rotation of the unipolar pacemaker into proper orientation with the active uninsulated surface directed towards the skin also solved the problem temporarily.
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El Gamal M, Van Gelder B. Suppression of an external demand pacemaker by diaphragmatic myopotentials: a sign of electrode perforation? Pacing Clin Electrophysiol 1979; 2:191-5. [PMID: 95280 DOI: 10.1111/j.1540-8159.1979.tb05200.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transient pacemaker inhibition was observed in a patient with an external bipolar demand pulse generator. Recordings of the proximal, distal and bipolar electrograms showed extracardiac myopotentials only in the unipolar distal and bipolar configuration. These myopotentials which caused inhibition of the pulse generator were related to respiration and other maneuvers that resulted in active contraction of the diaphragm, thus proving their diaphragmatic origin.
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Fontaine G, Frank R, Petitot JC, Grosgogeat Y. Risks of delayed potentials in pacemaker patients prone to ventricular tachycardia. Pacing Clin Electrophysiol 1978; 1:465-71. [PMID: 95639 DOI: 10.1111/j.1540-8159.1978.tb03508.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Late potentials occurring after completion of the QRS complex have been observed in patients prone to ventricular tachycardia. They were recorded either during epicardial studies or in the catheterization laboratory. This paper describes such abnormal myocardial activity and discusses their potential effects on cardiac pacemakers.
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Waxman HL, Lazzara R, El-Sherif N. Apparent malfunction of demand pacemakers due to spurious potentials generated by contact between two endocardial electrodes. Pacing Clin Electrophysiol 1978; 1:531-4. [PMID: 95648 DOI: 10.1111/j.1540-8159.1978.tb03517.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Malfunction of both temporary and permanent demand transvenous pacemakers was caused by contact between the two endocardial electrodes. Contact between these electrodes created spurious potentials which resulted in irregular inhibition of both demand units. The potentials were demonstrated by recording from the temporary wire. There was no interference with either pacemaker in the fixed rate mode and malfunction ceased when the temporary wire was removed.
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Barold SS, Ong LS, Falkoff MD, Heinle RA. Inhibition of bipolar demand pacemaker by diaphragmatic myopotentials. Circulation 1977; 56:679-83. [PMID: 902394 DOI: 10.1161/01.cir.56.4.679] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This report describes inhibition of a normally functioning bipolar demand pulse generator by diaphragmatic myopotentials. Transient pacemaker suppression occurred repeatedly with deep respiration, straining, the Valsalva maneuver, coughing, sneezing and laughing. When the magnet was applied, none of these maneuvers inhibited the pacemaker. Extensive investigations ruled out an intermittent electrode problem such as a wire fracture or insulation break. Sensing of diaphragmatic myopotentials should be considered in the differential diagnosis of unexplained pacemaker pauses.
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