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The Analog Blanking Period of Implantable Cardiac Rhythm Devices
Author(s) -
BAROLD S. SERGE,
KUCHER ANDREAS
Publication year - 2017
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/pace.12982
Subject(s) - medicine , atrial flutter , cardiology , ventricle , supraventricular arrhythmia , atrium (architecture) , atrial fibrillation
Background Analog blanking periods (BPs) that hold down the display of electrograms (EGMs) in cardiac rhythm devices have received much less attention than the well‐known digital BPs which do not influence the EGM display. In Biotronik devices (Biotronik GmbH, Berlin, Germany), when a paced event initiates an analog BP in one chamber (right atrium, right ventricle [RV], or left ventricle [LV]), an identical cross‐chamber analog BP starts in the other two chambers. Methods All clinical observations were recorded from patients with Biotronik devices. The effect of the atrial cross‐chamber analog BP initiated by a ventricular paced event on the atrial EGM was studied in the records of seven patients with frequent paroxysmal atrial flutter to determine the effect of critically timed RV paced event (RVp) or LV paced event (LVp) upon the atrial EGM. The effect of atrial pacing triggering cross‐chamber analog BPs in the RV and LV channels on the RV and LV EGMs was also investigated in cases of conducted supraventricular beats and ventricular premature complexes. The effect of a triggered LVp initiating a cross‐chamber analog BP in the RV channel on the EGM of a sensed RV sensed event was evaluated in 10 cases. Simulation studies were also performed to verify the clinical observations. Results Patients with atrial flutter showed intermittent truncation or deformity and even disappearance of the atrial signals due to an atrial cross‐chamber analog BP initiated by RVp and/or LVp. Three patients demonstrated deformity of the signal shape of ventricular premature beats falling within a ventricular cross‐chamber analog BP initiated by right atrial paced event (RAp). We found only one case of a supraventricular QRS complex trapped in a ventricular cross‐chamber analog BP initiated by RAp. All the recordings of LVp triggering upon RVs revealed a variety of RV signal deformities occasionally with preservation of the terminal part of the RV signal. Simulation studies confirmed the effect of the analog BP on the atrial and the ventricular EGMs. Conclusion The analog BP of Biotronik devices may cause truncation or deformity of atrial and ventricular signals and the occasional disappearance of an atrial signal during atrial flutter. These effects must not be interpreted as device malfunction. In the clinical evaluation of the EGM curves, the effects of the analog BPs have to be carefully considered in order to avoid possible misinterpretation.