Kalp Pili İmplantasyonundan 12 Saat Sonra Elektrot Empedansı, Algılama ve Uyarı Eşiği Değişikliklerinin Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, kalp pili implantasyonundan sonraki ilk 12 saat içinde elektrot empedansı, algılama ve uyarı eşiği değerlerindeki erken değişiklikleri değerlendirmektir.Yöntem: Ocak 2024 ile Aralık 2024 tarihleri arasında cihaz implantasyonu yapılan toplam 50 hasta bu prospektif çalışmaya dahil edildi. Elektrot empedansı, algılama amplitüdü ve uyarı eşiği değerleri implantasyondan hemen sonra ölçüldü ve 12 saat sonra tekrar değerlendirildi. İki zaman noktası arasındaki değişiklikler istatistiksel olarak analiz edildi. Bulgular:İmplantasyondan sonraki ilk 12 saat içinde elektrot empedans değerlerinde anlamlı bir azalma gözlendi (p<0,05). Buna karşılık, algılama amplitüdleri ve uyarı eşiklerinde göreceli olarak stabilite gözlendi ve istatistiksel olarak anlamlı bir değişiklik tespit edilmedi (p>0,05). Hem atriyal hem de ventriküler elektrotlar, algılama veya uyarma etkinliğini etkilemeden benzer empedans düşüşü paternleri sergiledi. Sonuç: Bu çalışma, kalp pili implantasyonunu takiben ilk 12 saat içinde elektrot empedansında anlamlı bir erken düşüş olduğunu, ancak algılama ve uyarı eşiği değerlerinin stabil kaldığını göstermektedir. Bu bulgular, modern kalp pili ve defibrilasyon elektrotlarının kısa vadede güvenilirliğini doğrulamakta ve cihaz implantasyonunu takiben elektrot parametrelerinin erken izlenmesinin önemini vurgulamaktadır.

Anahtar Kelimeler

• Kalp pili
• Elektrot empedansı
• Algılama eşiği
• Uyarı eşiği

Evaluation of Electrode Impedance, Sensing, and Pacing Threshold Changes at 12 Hours After Pacemaker Implantation

Öz

Objective: The aim of this study was to evaluate the early changes in electrode impedance, sensing, and pacing threshold values within the first 12 hours after pacemaker implantation. Methods: A total of 50 patients who underwent device implantation between January and December 2024 were included in this prospective study. Lead impedance, sensing amplitude, and pacing threshold were measured immediately after implantation and reassessed at 12 hours post-implantation. Changes between the two time points were statistically analyzed. Results: Lead impedance values significantly decreased within the first 12 hours following implantation (p<0.05). In contrast, sensing amplitudes and pacing thresholds remained relatively stable, and no statistically significant changes were observed (p>0.05). Both atrial and ventricular leads demonstrated similar patterns in impedance reduction without compromising sensing or pacing efficacy. Conclusion: This study demonstrates that a significant early decrease in lead impedance occurs within the first 12 hours after pacemaker implantation, while sensing and pacing thresholds remain stable. These findings confirm the short-term reliability of modern pacing and defibrillation leads and highlight the importance of early monitoring of lead parameters following device implantation.

Anahtar Kelimeler

• Pacemaker
• Electrode impedance
• sensing threshold
• Pacing threshold

Kaynakça

1. Biffi M, Boriani G, Ziacchi M, et al. Pacing devices to treat bradycardia: current status and future perspectives. Expert Rev Med Devices. 2021;18(2):161–177. doi: 10.1080/17434440.2021.1866543.
2. Puette JA, Malek R, Ahmed I, Ellison MB. Pacemaker Insertion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526001/
3. De Vries LM, de Jong JSSG, van Dessel PFHM, BH Stricker, NM van Hemel. Utilisation of cardiac pacemakers over a 20-year period: results from a nationwide pacemaker registry. Neth Heart J. 2017;25(1):47–55. doi: 10.1007/s12471-016-0880-0.
4. Matchett M, Sears SF, Hazelton G, Kirian K, Wilson E, Nekkanti R. The implantable cardioverter defibrillator: its history, current psychological impact and future. Expert Rev Med Devices. 2009;6(1):43–50. doi: 10.1586/17434440.6.1.43.
5. Mulpuru SK, Madhavan M, McLeod CJ, Yong-Mei Cha, Friedman PA. Cardiac pacemakers: function, troubleshooting, and management: part 1 of a 2-part series. J Am Coll Cardiol. 2017;69(2):189–210. doi: 10.1016/j.jacc.2016.10.061.
6. Swerdlow CD, Koneru JN, Gunderson B, Kroll MW, Ploux S, Saxon LA. Impedance in the diagnosis of lead malfunction. Circ Arrhythm Electrophysiol. 2020;13(2):e008092. doi: 10.1161/CIRCEP.119.008092.
7. De Buitleir M, Kou WH, Schmaltz S, Morady F. Acute changes in pacing threshold and R- or P-wave amplitude during permanent pacemaker implantation. Am J Cardiol. 1990;65(15):999–1003. doi: 10.1016/0002-9149(90)91003-O.
8. Timmis GC, Helland J, Westveer DC, Stewart J, Gordon S. The evolution of low threshold leads. J Cardiovasc Electrophysiol. 1990;1:313–334. doi: 10.1111/j.1540-8167.1983.tb01632.x.

9. Mond HG, Stokes K, Helland J, Grigg L, Kertes P, Pate B, Hunt D. The porous titanium steroid eluting electrode: a double-blind study assessing the stimulation threshold effects of steroid. Pacing Clin Electrophysiol. 1988;11(2):214–219. doi: 10.1111/j.1540-8159.1988.tb04543.x.
10. Hagiwara H, Morimoto J, Tamura T, Takahashi A, Komoriyama H, Kato Y, Anzai T. Leadless pacemaker with acute but transient elevation of lead impedance and pacing threshold. Can J Cardiol Open. 2023;5(6):412–414. doi: 10.1016/j.cjco.2022.12.006.
11. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Circulation. 2008;117:e350–e408. doi: 10.1161/CIRCULATIONAHA.108.189742.
12. Hansky B, Vogt J, Gueldner H, et al. Implantation of active fixation leads in coronary veins for left ventricular stimulation: report of five cases. Pacing Clin Electrophysiol. 2007;30(1):44–49. doi: 10.1111/j.1540-8159.2007.00578.x.
13. Wang T, Pan Y, Zhang C, Zhan S, Sun B, Li D. Lead fixation in deep brain stimulation: comparison of three lead anchoring devices in China. BMC Surg. 2019;19:88. doi: 10.1186/s12893-019-0558-9
14. León AR, Delurgio DB, Mera F. Practical approach to implanting left ventricular pacing leads for cardiac resynchronization. J Cardiovasc Electrophysiol. 2005;16(1):100–105. doi: 10.1046/j.1540-8167.2005.04600.x.
15. Paech C, Kostelka M, Dähnert I, Flosdorff P, Riede FT, Gebauer RA. Performance of steroid eluting bipolar epicardial leads in pediatric and congenital heart disease patients: 15 years of single center experience. J Cardiothorac Surg. 2014;9:84. doi: 10.1186/1749-8090-9-84.
16. Biffi M, Boriani G, Ziacchi M, et al. Electrical performance and lead handling evaluation of a new active fixation left ventricular lead: results of an Italian multicenter experience. EP Europace. 2016;18(suppl_1):i76. doi: 10.1093/europace/18.suppl_1.i76
17. Kimata A, Yoshida K, Takeyasu N, et al. Bradycardia-dependent rise in the atrial capture threshold early after cardiac pacemaker implantation in patients with sick sinus syndrome. HeartRhythm Case Rep. 2015;2(1):27–31. doi: 10.1016/j.hrcr.2015.08.012
18. Archontakis S, Oikonomou E, Sideris K, et al. Safety of same-day discharge versus overnight stay strategy following cardiac device implantations: a high-volume single-centre experience. J Interv Card Electrophysiol. 2023 Mar;66(2):471-481. doi: 10.1007/s10840-022-01319-5.
19. Canabal A, Hortigüela V, Raigal A, et al. Foreseeable variation in parameters measured at implant and follow-up of permanent pacemaker active fixation electrodes. Med Intensiva. 2012;36(4):270–276. doi: 10.1016/j.medin.2011.11.001
20. Fuertes B, Toquero J, Arroyo-Espliguero R, Lazona FI. Pacemaker lead displacement: mechanisms and management. Indian Pacing Electrophysiol J. 2003;3(4):156–159.
21. Rhoden WE, Llewellyn MJ, Schofield SW, Bennett DH. Acute and chronic performance of a steroid-eluting electrode for ventricular pacing. Int J Cardiol. 1992;37(2):209–212. doi: 10.1016/0167-5273(92)90210-t
22. Levine PA. Management of the patient with an acute massive rise in the capture threshold. Indian Pacing Electrophysiol J. 2001;1(1):35–37.