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- Title
The Effect of Radiofrequency Catheter Ablation on Permanent Pacemakers: An Experimental Study.
- Authors
Chin, Michael C.; Rosenqvist, Marten; Lee, Michael A.; Griffin, Jerry C.; Langberg, Jonathan J.
- Abstract
Radiofrequency current is being investigated as an alternative to direct current shock for transcatheter ablution of cardiac arrhythmias. Permanent pacemakers are known to be susceptible to high frequency electromagnetic interference. This study was performed to examine the effects of transcatheter radiofrequency ablation on permanent pacemakers in a worst-case scenario. Nineteen pulse generators representing 16 models from seven manufacturers were acutely implanted in 12 dogs to assess their function during and after ablation. Pulse generators were implanted subcutaneously in the neck and connected to a transvenous permanent pacing lead positioned in the right ventricular apex. A 6F quadripolar electrode catheter was positioned approximately 1 cm from the tip of the permanent pacing lead. Radiofrequency current from an electrosurgical unit was applied between the distal electrode of the catheter and a large diameter skin electrode placed below the left scapula. Three additional ablation sessions were performed with the catheter situated 4-5 cm from the permanent pacing lead. Each ablution consisted of 15 W of radiofrequency power, delivered for up to 30 seconds. Twelve pulse generators were falsely inhibited during radiofrequency ablation while programmed to the VVI or DDD mode, nine of which continued to be inhibited while programmed to the VOO or DOO mode. Five pulse generators paced at abnormal rates, including three examples of one pulse generator model that displayed pacemaker runaway. Runaway was observed during eight ablations, resulting in two episodes of ventricular fibrillation. Eleven pulse generators reverted to noise mode behavior during ablation. Only three pulse generators were unaffected during ablation. No reprogramming or pacing system malfunctions were observed after cessation of radiofrequency current application or during oblations > 4 cm from the permanent lead. No changes in lead impedance, sensing, or capture threshold were observed, in conclusion, transcatheter radiofrequency ablation within close proximity of a permanent pacing lead may falsely inhibit implanted pulse generators, induce pacemaker runaway, or cause pulse generators to revert to noise mode behavior. Radiofrequency ablution performed in patients with permanent pacemakers requires careful monitoring as well as backup external pacing. A complete pacing system analysis should be performed following each ablation.
- Subjects
RADIO frequency; CATHETER ablation; ARRHYTHMIA; HEART beat; RADIO interference; CARDIAC arrest
- Publication
Pacing & Clinical Electrophysiology, 1990, Vol 13, Issue 1, p23
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/j.1540-8159.1990.tb01999.x