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Objective To investigate the clinical significance of 24-hour ambulatory electrocardiography (AECG) in patients with pacemaker implantation. Methods A total of 65 patients with pacemaker implantation were selected as research subjects, and all of them both underwent routine 12 lead electrocardiogram(ECG) and 24-hour AECG. The detection rates of pacemaker dysfunction [ abnormal pacing, and abnormal perception (absence of atrial perception, atrial over perception, absence of ventricular perception and ventricular over perception)], special functions of pacemaker ( pacing mode switching, frequency response, frequency lag, dynamic threshold monitoring and ventricular pacing management ), self arrhythmias ( atrial tachycardia, paroxysmal atrial fibrillation, atrial premature beats and premature ventricular beats), and pacemaker mediated arrhythmias (atrioventricular block, pacemaker mediated tachycardia, rapid rate and ventricular escape) separately by the two examination methods were compared. Results By using 24-hour AECG, the detection rates of pacemaker dysfunction and abnormal perception, and special functions of pacemaker such as pacing mode switching and frequency response were all significantly higher than those of routine ECG (P<0. 05). The detection rates of self arrhythmias and pacemaker mediated arrhythmias were also significantly higher than those of routine ECG (P< 0. 05). Conclusion The 24-hour AECG examination could effectively detect the working state of pacemaker in patients implanted with pacemaker, and sensitively make judgment of pacemaker dysfunction and cardiovascular events such as arrhythmias. [ABSTRACT FROM AUTHOR]

BACKGROUND: Reel's syndrome is a rare disease with unknown etiology, which is due to the rotation of the pacemaker generator in its transverse axis with subsequent winding of the leads causing early failure in the stimulation of a low-energy heart device. CLINICAL CASE: A 60-year-old patient with a dual-chamber pacemaker with early failure of his device who presented recently-onset diaphragmatic stimulation, and whose exploration showed pacing failure confirmed with chest X-ray, it showed ascent of atrial and ventricular electrodes different from the initial position that the patient presented. In the control Reel's syndrome was subsequently diagnosed. CONCLUSIONS: The incidence of presentation is low and poor described, what has been reported so far is specified in high-energy devices and with multiple risk factors that promote the appearance of early failure of cardiac pacing. [ABSTRACT FROM AUTHOR]

Compared with traditional right ventricular apical pacing, His-bundle pacing (HBP) provides more physiologic pacing by activating the normal conduction system. However, HBP has some limitations including higher pacing thresholds. In addition, disease in the distal His-Purkinje system may prevent the correction of abnormal conduction. Left bundle branch pacing (LBBP) may overcome these disadvantages by providing lower pacing thresholds and relatively narrow QRS duration that improve cardiac function. Here, we describe a rare case of a transient loss of ventricular capture due to acute anterior wall myocardial infarction in an LBB-paced patient. With the improvement of the ischemia, the function of the pacemaker partly recovered. We review the adaptations, advantages, and limitations, and long-term safety of LBBP.

Background Syncope in a patient with a pacemaker is a serious event requiring urgent action to ascertain its cause. Around 5% of cases are due to a pacemaker system malfunction. Case summary An 82-year-old man underwent dual-chamber permanent pacemaker implantation due to intermittent high-degree atrioventricular block (AVB) in sinus rhythm. Nine months later, the patient reported episodes of syncope. The chest X-ray showed both leads to be at their expected positions. The electrocardiography (ECG) showed common atrial flutter. Ventricular capture during pacing in atrial demand pacing (AAI) mode confirmed cross-stimulation due to the switching of the atrial and ventricular leads at the pacemaker header. Discussion Cross-stimulation is a rare possibility in a differential diagnosis of causes of syncope. The diagnosis is frequently made during the procedure or a few hours later. The lack of symptoms during 9 months in this case was likely due to the patient having normal sinus rhythm with preserved AV conduction most of the time, as well as ventricular capture from the atrial lead related to non-sensed P waves. When atrial arrhythmias occurred, the sensing of the F waves inhibited ventricular pacing. In order to avoid this complication, in patients with intermittent bradycardia, pacing at a slightly higher heart rate during implantation of the device should be recommended to see the chamber paced with the surface ECG connected to the device interrogator. The ECG and electrogram (EGM) should correlate during device interrogation in order to identify this complication.) [ABSTRACT FROM AUTHOR]

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Takotsubo syndrome is an acute reversible heart failure syndrome triggered by physical or emotional stress, especially in postmenopausal women. Herein, we describe a case of a 31-year-old pacemaker dependent lady who presented with syncope after she was bereaved of her father. Electrocardiogram at admission revealed ventricular paced rhythm at 60/min, prolonged QT interval and frequent runs of torsades de pointes. Transthoracic echocardiogram and left ventriculogram revealed findings typical of Takotsubo syndrome. QT prolongation and torsade de pointes in the context of fixed-rate ventricular pacing imply direct catecholamine toxicity on the ventricular myocardium independent of heart rate. [ABSTRACT FROM AUTHOR]

Competing Interests: All the authors declare no conflict of interest.

Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed. The possible mechanisms for these effects are discussed and recommendations for the management of cardioversion in patients with permanent pacemaker systems are given. [ABSTRACT FROM PUBLISHER]

Copyright of Clinical Research in Cardiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Electromagnetic fields arising from a variety of different sources have been shown to interfere with normal pacemaker function. This study evaluated the possible interactions between two modern security systems and different pacemaker types. Fifty-three patients (27 single chamber pacemakers, 25 dual chamber pacemakers) have been tested routinely for their pacemaker function. Thirty-eight patients presented with unipolar sensing and 15 with bipolar sensing. The patients were asked to walk through an installed security system, an antitheft device, and electromagnetic access device with different field strengths while a six-channel ECG monitored the patients. The pacemaker systems were first measured in their basic programmed modes, then the intervention frequency was changed to 100/min and, thereafter, the maximum sensitivity without T wave oversensing was added. In the security system with the highest field strength (2,700 mA/m), a pacemaker malfunction could be observed in 13% of the monitored patients. In one case, a pacemaker (VVIR) switched to ventricular safety pacing (VOO mode). In the security system with the lower field strength (1,600 mA/m) we found a pacemaker malfunction in 4% of the tested patients. In the antitheft device (50 mA/m). in the electromagnetic access device (300 mA/m), and in pacemaker systems with bipolar sensing, none of these dysfunctions were observed. Phantom programming as described previously did not occur in any of the systems. Persons who are often in the vicinity of security systems should be equipped with a bipolar pacemaker system. Our findings indicate that patients with pacemakers should avoid contact with security systems. [ABSTRACT FROM AUTHOR]

Transient cardiac apical ballooning syndrome (TCABS) is diagnosed by transthoracic echocardiography demonstrating apical akinesis with left ventricular (LV) apical ballooning and preserved mid-to-basal LV systolic function, and left heart catheterization showing the absence of significant obstructive epicardial coronary artery disease. Presenting symptoms are suggestive of an acute coronary syndrome and electrocardiogram findings mimic acute myocardial injury. Right ventricular involvement has been reported. We describe a case of acute pacemaker dysfunction caused by the TCABS, which responded to conservative therapy. [ABSTRACT FROM PUBLISHER]

The pacemaker is the treatment of choice for symptomatic bradycardic arrhythmias. However, pacemaker patients may develop further bradycardial arrhythmias, often due to a pacemaker dysfunction. The possible causes range from lead problems to complete system failure. The Nanostim TM system is a leadless pacemaker. The advantages include the lead-free design and the catheter-based implantation. In 2016, all Nanostim TM implantations were stopped due to a battery dysfunction.

CHINUSHI, Y., et al.: Microdislodgment of Ventricular Pacing Lead Undetectable During Rapid Pacing One Year After Implantation. A 71-year-old woman had undergone valvular heart surgery in 1981, and implantation of a permanent ventricular pacemaker for ventricular pauses during atrial fibrillation in 2001. One year after pacemaker implantation, she complained of faintness. When pacing at 100 beats/min the pacemaker functioned properly. However, pacing and sensing failure was detected at a pacing rate of 60 beats/min. At rapid pacing rates, the lead tip was in closer contact with the endocardium, and its microdislodgment was undetectable. The symptoms have resolved since the lead was repositioned. (PACE 2003; 26:787–788). [ABSTRACT FROM AUTHOR]

Introduction: We sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups., Material and Methods: Ambulatory 24-hour Holter recordings (HM) were performed in 100 patients with DDD pacemakers 1 day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances., Results: Despite proper sensing and pacing parameters, HM revealed PM disturbances in 23 patients out of 100 (23%). Atrial undersensing episodes were found in 12 patients (p < 0.005) with totally 963 episodes and failure to capture in 1 patient (1%). T wave oversensing was the most common ventricular channel disorder (1316 episodes in 9 patients, p < 0.0005). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found., Conclusions: Asymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation. Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogram PM parameters.