High impedance alert with safety switching: An unreported hazard of hybrid pacing systems

J Cardiovasc Electrophysiol. 2019 Jul;30(7):1102-1107. doi: 10.1111/jce.13941. Epub 2019 Apr 22.

Abstract

Several Boston Scientific pacemaker models have a known issue with intermittent oversensing of the minute ventilation sensor when paired with non-Boston Scientific leads. Several of our patients with these hybrid systems have had transient out of range impedances and oversensing after safety switching which we suspected may be related. A retrospective analysis of 395 patients who had pacemakers implanted between 2015-2017 found that transient out of range impedances with safety switching was present in 9% of Boston Scientific pacemakers paired with Abbott or Medtronic leads compared with 0% in other device-lead combinations (P = 0.0089). We postulate that the root cause of the minute ventilation oversensing and transient high impedance issue is the same, a header-lead interaction from low-level incompatibility. Recognizing this issue is critical to prevent unnecessary lead revisions or extractions as it can be prevented with a simple reprogramming of lead pace/sense configuration.

Keywords: header; impedance; lead fracture; minute ventilation; safety switch.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Action Potentials
  • Aged
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / physiopathology
  • Arrhythmias, Cardiac / therapy*
  • Cardiac Pacing, Artificial / adverse effects*
  • Device Removal
  • Electric Impedance
  • Equipment Design
  • Equipment Failure
  • Female
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome