Difference in Measured Amplitude of Intracardiac Electrocardiogram between Pacing System Analyzers during Implantation and Programmer after Implantation

Abstract

Discrepancies in of amplitudes of intracardiac electrograms are often observed between pacing system analyzers (PSA) during implantation and programmer just after the operation. We conducted this study to clarify the reason for this phenomenon. The study subjects were 80 patients who underwent pacemaker implantation or replacement. Their mean age was 78 years old, and 38 were males. Amplitudes of intracardiac P and R waves were measured and compared by using PSA during implantation and by programmers of specific manufacturers just after the operation. Furthermore, we performed a simulation to measure and compare artificial P and R waves by PSA and programmer. No significant difference was found in the measurement of R wave. On the other hand, the amplitude of P wave measured by the programmers was significantly higher than its amplitude when measured by PSA. We also found that this gap differed depending on the manufacturer. This tendency was still observed even in 24 patients who underwent generator replacement. The results of simulation supported these findings, and we concluded that the peculiar settings of sensing filters of PAS and programmers may play a role in these differences. We should pay attention to the difference in the amplitude of intracardiac electrograms, especially P wave, when measured by PSA and programmers.