Initial and Early Follow-up Assessment of the Clinical Efficacy of a Multiparameter-Programmable Puise Generator

Recent advances in pacemaker technology have produced noninvasively multiparameter-programmable puise generators that have the potential for resolving complications that result from the pacing system and forproviding a mechanism whereby adjustments can be made for the specific needs of a patient without corapromising reliability and longevity. These applications were assessed by analyzing the initial indications, clinical efficacy, and reliability in 100 consecufive patients who received a multiparameter-program-mable puJse generator. Data analysis showed that 78% of the 100 patients had changes in rate programmed, 16% in pufse width, and 5% in sensitivity. Program-mability was utilized for voJtage amplitude (one patient) but was not utilized for hysteresis and refractory period. Although progrtimming changes (rate and pulse width) generally could have been accomplished with simpler units, program-mability for sensitivity made it possible to solve pacemaker problems in five patients and clearly eliminated the need for reoperation in two patients. The compact size of the multiparameter-programmable pulse generator has allowed its use in patients in the pediatric age group, patients with a small frame, and patients with a major concern about cosmetic appearance. Programming sensitivity for proper sensing of the atrial signal allows use of the multiparameter-programmable pulse generator as an atrial pacemaker. This was done in one pediatric patient who also benefited from suppression of atrial overdrive. There have been no episodes of spurious programming. Reliabitity has not been sacrificed by the increased complexity of this unit. If preimplant criteria for use of a multiparameter-program-mable puise generator are too sfrict, this may limit its potential therapeutic value because the need for its flexible characleristics is unpredictable.