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American Journal of Roentgenology, Vol 100, 446-456, Copyright © 1967 by American Roentgen Ray Society

INTERNAL CARDIAC PACEMAKERS

JOSEPH TABRISKY M.D.1, WILLIAM E. JOBE M.D.1, MELVIN B. NEWMAN M.D.1, and CHARLES E. SEIBERT M.D.1

1 From the Departments of Surgery and Radiology, National Jewish Hospital, Denver, Colorado

There are two main pacemaker systems used in controlling the cardiac rate in Severe heart-block patients: (1) asynchronous, and (2) synchronous or P-wave actuated.

These pacemakers transmit current to the electrodes by direct wire or electromagnetic communications.

The main techniques of applying the myocardial electrodes to the ventricles are: (1) transvenously into the right ventricle, or (2) onto the cardiac surface via a thoracotomy.

The safety extension wires are a useful means of testing, stopping, bypassing, or increasing output of the pacemaker without disrupting its position or contents.

The most common complication is wire fracture. Useful clues in detecting breaks require observation for muscle twitching due to current leaks from the fractured wire. Roentgenograms of the suspected area, taken with different obliquities, are a necessity.

Battery exhaustion is anticipated by persistent pulse changes but a radiographic method of analysis can depict various stages of mercury battery depletion.

A polyvinyl sponge backing the Chardack electrode can give the appearance of a false aneurysm. This is easily differentiated from a true aneurysm by fluoroscopy and roentgenography.

Intracavitary electrode placement in the right ventricular apex has occasionally resulted in perforation of the myocardial wall. Lateral roentgenograms are helpful in revealing the complication.

Electrical hazards from the use of improperly grounded hospital equipment are more acute in patients who are attached to line-powered pacemakers. Small, usually harmless, currents can induce ventricular fibrillation.

Certain radio-frequency emitting apparatus such as diathermy and betatron therapy units should be avoided as they may interfere with the pacemaker's transistors and consequently cause serious arrhythmias.

Rarely, the pacemaker may initiate ventricular arrhythmias if the artificial stimulus occurs during the vulnerable period of the cardiac cycle in an excessively irritable heart.


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Copyright © 1967 by the American Roentgen Ray Society.