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Selective Dysfunction of Ventricular Electrode‐Endocardial Junction Following DC Cardioversion in a Patient with a Dual Chamber Pacemaker
Author(s) -
DAS GOPAL,
STAFFANSON D.B.
Publication year - 1997
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1997.tb06184.x
Subject(s) - medicine , cardiology , paddle , lead (geology) , shock (circulatory) , shunting , cardioversion , ventricular pacing , electrophysiology , ventricular fibrillation , anesthesia , atrial fibrillation , heart failure , mechanical engineering , geomorphology , engineering , geology
A patient with a dual chamber pacemaker received two transthoracic (anterior‐anterior paddle position) shocks for VF. Subsequent analysis of stimulation thresholds revealed a marked rise in the ventricular threshold only. Later, she received three additional shocks (anterior‐posterior paddle position) during electrophysiological study to terminate episodes of induced VT. Following these, the ventricular stimulation threshold was > 10 Vat 2.0 ms. The selective damage at the ventricular site in this patient led us to carry out in vitro studies that revealed a preferential shunting of high electrical energy into the ventricular lead, as compared to the atrial lead, following a DC shock. These observations may explain the selective pacing malfunction observed in our patient.