What are signs of inappropriate sensing and capture in perioperative management of permanent pacemakers (PPMs) and automatic implantable cardioverter-defibrillators (AICDs)?

Updated: Oct 29, 2018
  • Author: Albert H Tsai, MD; Chief Editor: Sheela Pai Cole, MD  more...
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Answer

Answer

Signs of inappropriate sensing and capture include the following:

  • Absence of pacing spikes when the native heart rate is below the pacer lower limit (oversensing)
  • Presence of aberrant pacing spikes when the native heart rate is above the lower limit (undersensing)
  • Presence of pacing spikes without corresponding atrial or ventricular depolarizations (noncapture) as observed on ECG or telemetry

Additionally, CIEDs with depleting battery lives frequently convert to safe mode or end-of-life mode to conserve power, and such conversion may manifest as loss of rate-adaptive therapy and a lower-than-expected paced rate.

If the aforementioned defects are suspected, the patient may require further interrogation, sensitivity or output adjustments, battery replacement, or some combination thereof.


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