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. 2022 Jun 14;38(4):615-621.
doi: 10.1002/joa3.12745. eCollection 2022 Aug.

High-impedance alerts with pulse generator-Lead mismatch

Simon Christie  1 , Nada El Tobgy  1 , Colette M Seifer  1 , Clarence Khoo  1
Affiliations

High-impedance alerts with pulse generator-Lead mismatch

Simon Christie et al. J Arrhythm. .

Abstract

Background: Cardiac Implantable Electronic Devices (CIED) include pulse generators and leads. In some implanting centers, it is a common practice to combine devices with leads from different companies. Case series have reported episodic high-impedance changes in Boston Scientific CIEDs with competitor leads. We investigated the incidence of high-impedance abnormalities in matched versus mismatched Boston Scientific Accolade pacemakers.

Methods: A retrospective chart review identified all consecutive Boston Scientific Accolade pacemakers implanted between January 2017 and June 2019 at a Canadian tertiary care center. The primary outcome was the occurrence of transient, high-impedance changes which resulted in a switch to unipolar pacing/sensing in the absence of any other identifiable lead issue. Fisher exact tests (two-tailed, α = .05) were used to compare the incidence of outcomes in matched versus mismatched systems.

Results: 514 Boston Scientific Accolade pacemakers were associated with 882 individual leads. The primary outcome occurred with 21 leads (20 Medtronic and 1 Abbott), associated with occasional pacing inhibition, presyncope, and/or early surgical revision. Mismatched lead-device pairs were significantly associated with CIED malfunction compared to matched lead-device pairs (3.3% vs. 0%, p = .0019). The median time from implant to unipolar safety switch was 12.4 months. The median follow-up time was 21.6 months.

Conclusion: Use of mismatched leads with a Boston Scientific Accolade device was associated with an increased risk of undesirable changes in sensing polarity with occasional inappropriate pacing inhibition. Awareness of this interaction can allow for the institution of appropriate programming remedies and may increase scrutiny of the use of mismatched CIED systems.

Keywords: high‐impedance alert; pacemaker; pacemaker Lead mismatch.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Distribution of matched and mismatched lead‐device pairs within the study population. “N” values denote the number of patients with specified pacing systems; all other values denote the number of lead‐device pairs. Boxes with grey background denote matched lead‐device pairs.
FIGURE 2
FIGURE 2
Lead impedance trends of an atrial lead with safety switch obtained during pacemaker interrogation. Note the sudden and transient spike in atrial lead impedance to >3000 Ω (arrow) with stable, normal lead impedances before and after. In this patient, an atrial lead safety switch was triggered in association with the lead impedance spike.
FIGURE 3
FIGURE 3
Intracardiac tracing demonstrating inappropriate ventricular pacing inhibition because of oversensing of lead noise in unipolar sensing mode. Note artifactual noise on the ventricular channel with the absence of ventricular pacing or intrinsic ventricular activity. This particular event corresponded to patient complaints of presyncope. VP = ventricular paced event, VS = ventricular sensed event, VT = ventricular sensed event annotated as ventricular tachycardia because of short V‐V interval.
See this image and copyright information in PMC

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