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(Chest. 1973;63:598-606.)
© 1973 American College of Chest Physicians

Evaluation of Demand Pacemakers by Chest Wall Stimulation

S. Serge Barold M.R.A.C.P.1; John J. Gaidula M.D.2; Roque Castillo M.D.3; Anwer Masood M.D.1; and J. Walter Keller M.S.4

1 Chief of Cardiology, The Genesee Hospital; Associate Professor of Medicine, University of Rochester School of Medicine and Dentistry
2 Associate Attending Physician in Medicine, Highland Hospital; Clinical Instructor in Medicine, University of Rochester School of Medicine and Dentistry
3 Department of Medicine, The Genesee Hospital and Highland Hospital and the University of Rochester School of Medicine and Dentistry, Rochester, New York; Research Division, Miami Heart Institute, Miami Beach, Florida
4 Director of Biomedical Engineering, Research Division, Miami Heart Institute

Chest wall stimulation (CWS) is a simple and safe technique for studying the sensing function of implanted demand pulse generators. Suppression of a demand pulse generator may be useful in the following circumstances: analysis of the underlying spontaneous electrocardiogram; investigation of dizziness and syncope; appropriately timed CWS may demonstrate the capability of a generator to sense the QRS signal. This avoids measures to accelerate the spontaneous rhythm in patients with generators pacing continuously; and suppression of a generator that fails to sense the QRS complex suggests a low electrographic signal. CWS permits evaluation of certain clinically important technical aspects of demand pulse generators and thus provides a model for the study of arrhythmias originating from the sensing mechanism. This information may be useful because some specifications published by manufacturers may occasionally be incorrect or incomplete. These characteristics include determination of delivery (paced), sensing (sensed) and relative refractory periods of generators; detection and significance of partial recycling with certain generators; and interference test. Rarely when the magnetic reed switch becomes inoperative and carotid sinus pressure cannot slow the spontaneous rate sufficiently to allow escape of the pacemaker, rapid CWS may reveal the pacing capability of a generator by pushing it into its interference phase. CWS should not be used to test the sensitivity of demand pacemakers while serial determination of refractory periods appears to be of no value in predicting or detecting pacemaker failure.






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Copyright © 1973 by the American College of Chest Physicians.