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The first transmission requires extra attention as most often, lead dysfunction occurs within a few days (weeks) after implant. The patient initiated transmission shows no alerts and the overview screen shows correct impedances and sensing values of the atrial and ventricular lead. Two general remarks can be made; 1) autothreshold could have been at least set to monitor in order enable better lead surveillance 2) the patient should be probably switched to DDD mode in the future as she is almost always paced in the ventricle.
The ventricular run episode included with the transmission requires careful analysis. It consists of three parts. The first part we see absence of signals except for some isolated oversensed artifacts. The second part shows a lot of noise with saturation (clipping) of the ventricular channel. The third part shows a normal ventricular EGM with ventricular pacing. Throughout these three parts, the atrial channel shows lack of physiological signal. Considering also the fact that the tracing was registered on the same day as the implantation, there can only be one diagnosis. The episode was registered during the connection of the RV lead into the header of the pacemaker. In this pacemaker model, during initial interrogation, the programmer enquires whether the implantation has been performed. When one confirms the implantation of the programmer, certain features such as recording of episodes, become active. If in fact the implantaiton has not been completed yet (such as in this case), we can expect such episodes to be registered and transmitted with the first transmission.
As the episode is associated with the implant, and as the leads show correct behavior ever since, there is no need to intervene. The implanter may be reminded to activate the pacemaker once it is implanted.
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Question 1 of 1
You receive a first tranmission sent by a dual chamber pacemaker (Alizea DR) implanted a week prior in a 79-year old woman with paroxysmal AV block.
Concerning the Ventricular run episode, which is the correct statement?CorrectIncorrect