Interactive Pacemaker Lead Analysis

●Case Overview

This application details the case of a patient with a pacemaker, tracking lead performance from implantation to a point of intermittent capture. The following parameters provide the baseline context for the device settings.

Mode

VVI

Base Rate

50 bpm

Max Sensor Rate

130 bpm

Sensor

Passive

Clinical History Timeline

Follow the patient's journey from initial implantation to the current clinical issue. Click on each event to expand its details and see how the lead parameters evolved.

Implantation

May 8, 2024

Initial parameters set at implantation. Stable performance reported post-procedure.

Capture: 1.5 V @ 2.7 ms

Sense: 1.5 mV

Impedance: 340 Ω

Parameter Adjustment

April 1, 2025

Device reprogrammed due to reports of nocturnal non-capture. Output was increased and pulse width decreased to conserve energy.

Capture: 3.0 V @ 0.4 ms

Sense: 4.0 mV

Impedance: 550 Ω

Est. Battery Life: 4.5 years

Current Issue: Intermittent Capture

June 19, 2025

Patient reports symptoms consistent with intermittent loss of capture, both during the day and at night. This prompts a full diagnostic review.

Parameter Trend Analysis

Visualizing the data from the clinical history helps to identify key trends. The charts below illustrate the changes in lead impedance, R-wave sensing, and the programmed pacing output over the last year.

Lead Impedance Trend (Ohms)

Sensing (R-Wave) Trend (mV)

Pacing Output Settings (Voltage & Pulse Width)

Diagnostic Algorithm & Proposed Solution

The current issue of intermittent capture requires a systematic approach. The following steps outline the diagnostic thought process. Use the interactive simulator to explore the potential outcomes of different programming adjustments.

Diagnostic Steps

Interactive Solution Simulator

3.0V @ 0.4ms (Current Setting) 3.5V @ 0.4ms (Increase Voltage) 4.0V @ 0.4ms (Further Increase) 3.0V @ 0.7ms (Increase Pulse Width)

!Final Recommendation

While this analysis and simulation suggest that increasing pacing output is necessary, the definitive "correct" voltage can only be determined by a qualified medical professional through an in-clinic evaluation. A formal pacing threshold test is required to find the precise minimum energy for capture and program a safe, efficient output, while investigating any underlying causes for the threshold rise.