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Management of the Patient with an Acute Massive Rise in the Capture Threshold

Levine, Paul A. (2001) Management of the Patient with an Acute Massive Rise in the Capture Threshold. [Journal (Paginated)]

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Abstract

Since the introduction of steroid eluting electrodes, the incidence of an early massive rise in the capture threshold that either exceeds or threatens to exceed the programmed output of the pacemaker has declined but has not totally disappeared1 If a persistent or massive threshold rise is encountered in the days to months post-implant, one consideration is microinstability of the lead. In this setting, there may be a change in the morphology of the pacemaker evoked depolarization on the ECG or a change in the physical location of the lead as assessed with a chest x-ray. Another marker is fluctuations in the capture threshold on repeated assessments at the same office or clinic visit. The options for this problem include an operative procedure to reposition or replace the lead or to closely observe the patient hoping that the lead settles into a secure location. Another potential totally reversible cause is the introduction of an new medication or herb. If the possible explanations for threshold increase cited above have been excluded and the high capture threshold is believed to be due to lead maturation, increasing the output or possible lead replacement or repositioning have been the usual options.

Item Type:Journal (Paginated)
Keywords:Acute Massive Rise in Capture Threshold; pacemaker
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4330
Deposited By:Indian Pacing and Electrophysiology, Journal
Deposited On:02 May 2005
Last Modified:11 Mar 2011 08:56

References in Article

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1. Danilovic D, Ohm OJ, Pacing threshold trends and variability in modern tined leads assessed using high resolution automatic measurements: Conversion of pulse width to voltage thresholds, PACE 1999; 22: 567-587 Medline

2. Nagatomo Y, Ogawa T, Kumagae H, Koiwaya Y, Tanaka K, Pacing failure due to markedly increased stimulation threshold two years after implantation: successful management with oral prednisolone, PACE 1989; 12: 1034-1037. Medline

3. Preston TA, Judge RD, Lucchesi BR, Bowers DL, Myocardial threshold in patients with artificial pacemakers, Am. J. Cardiol. 1966; 18: 83-89.

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5. Preston TA, Judge RD, Alterations of pacemaker threshold by drug and physiologic factors, Annals of the New York Academy of Sciences 1969; 167: 686-692.

6. Sowton E, Barr I, Physiologic changes in threshold, Annals of the New York Academy of Sciences, 1969; 167: 679-685.

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