Cross‐Stimulation During Lead Impedance Monitoring

Abstract

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.

Cross‐Stimulation: A Rare Complication of Chronic Epicardial Leads

“…In all of these cases cross‐stimulation was benign and again resolved with maturation of leads and subsequent increased thresholds. As expected, lead placement is another potential cause for cross‐stimulation 3,4,7 . If the atrial lead is placed such that it is in close proximity to right ventricular myocardium, cross‐stimulation can occur.…”

“…As expected, lead placement is another potential cause for cross-stimulation. 3,4,7 If the atrial lead is placed such that it is in close proximity to right ventricular myocardium, cross-stimulation can occur. Of note in these cases, the paced morphology is different than that observed during pacing via the ventricular lead as opposed to the above cases where the paced morphology is identical.…”

“…This was first described by Levine et al in 1985 3 . Since then, the majority of reported cases of cross‐stimulation have been caused by intrinsic design features of certain pacemaker and analyzer models, 3–6 or been associated with issues related to lead placement or trauma 7,8 . In such cases, cross‐stimulation has usually followed a benign course and resolved with minimal intervention.…”

“…3 Since then, the majority of reported cases of crossstimulation have been caused by intrinsic design features of certain pacemaker and analyzer models, [3][4][5][6] or been associated with issues related to lead placement or trauma. 7,8 In such cases, cross-stimulation has usually followed a benign course and resolved with minimal intervention. We report a case of cross-stimulation occurring as a complication in a patient with chronic epicardial leads with no prior history of trauma or injury to the pacing system.…”

Pseudo‐Cross‐Stimulation due to First Degree AV Block

“…This was first described by Levine et al 1 in 1985 and was attributed to several different causes. Subsequent reports 2–8 of this phenomenon have ascribed this to be due to either the proximity of the atrial lead to the ventricular chamber, or to the intrinsic design features of certain pacemakers and analyzers. Common to all cases has been the need for a very low ventricular capture threshold that allows pacing of the ventricle by output stimuli of relatively small amplitude.…”