Author Description

In the early days of cardiac pacing which began 30 years ago in 1958, the indications for pacing therapy and the potential malfunctions were relatively straight forward and simple in comparison to present experience. Today's pacing systems are capable of stimulating and sensing in both chambers of the heart, of interaction with a multiplicity of native arrhythmias, both slow and fast, of using independent sensors to guide the rate and for being noninvasively programmed to trillions of potential parameter combinations. Concomitant with the increased therapeutic utility of pacemaker therapy is a marked increase in the complexity of the rhythms and potential malfunctions that may occur with these systems. These normal and abnormal interactions must be evaluated by the physician in whom the therapeutic benefit is achieved while minimizing and preferably preventing any and all adverse consequences of pacing therapy. Pacemakers are incorporating ever increasing diagnostic capabilities, facilitating the ease with which the physician can evaluate and understand the pacing system, the patient's native rhythm and the interaction between both. This monograph prepared for Cardionstim '88 is directed towards exploring the diagnostic features incorporated in many pacemakers today. A series of cases are presented to challenge and excite the reader. All are real - non are simulations nor created specifically to demonstrate a point. The capabilities present at this time are likely to be expanded in the future and are a direct benefit to all provided by the tremendous technological growth resulting from man's exploration of space.