Cross-stimulation during lead impedance monitoring.
At the age of 4 years, a total cavopulmonary connection was performed in a boy with a complex congenital heart defect. On addition, a DDDR pacemaker was implanted for sick sinus syndrome. Atrial and ventricular leads were epicardially placed at the left atrium and left ventricle. At the age of 10 years, a new epicardial ventricular lead was placed because of malfunction of the existing lead. At the same operation the pulse generator was replaced by a Medtronic Kappa DR 731. After replacement, the boy experienced episodes of phrenic nerve stimulation associated with feelings of discomfort. Holter recordings revealed ventricular stimulation from the atrial stimulus for 2 consecutive beats. This phenomenon repeated exactly every 3 hours and was caused by the automatic lead impedance measurement that used a 5-V, 1-ms stimulus output.
Beaufort-Krol
G C
GC
Beatrix Children's Hospital Groningen, Division of Pediatric Cardiology University Hospital, The Netherlands.
Bink-Boelkens MTh
Nagelkerke
D
D
Van Gelder
B M
BM
D002648:Child; D017097:Electric Impedance; D004558:Electric Stimulation / Q000295:instrumentation; D015716:Electrocardiography, Ambulatory; D004867:Equipment Design; D004868:Equipment Failure; D006325:Heart Atria / Q000002:abnormalities; D018610:Heart Bypass, Right; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010791:Phrenic Nerve; D012804:Sick Sinus Syndrome / Q000628:therapy*