Electrocardiographic diagnosis of pacemaker catheter displacement

Abstract

Displacement of permanent pacemaker catheters occurs in about 10 per cent of primary implantations, and can be a cause of "pacemaker failure." If movement of the catheter tip is 2 cm. or less there is usually no change of the stimulus artifact on the standard ECG, but marked changes in catheter position do result in changes of the amplitude and direction of the pacemaker stimulus artifact. Four episodes of catheter displacement resulted in changes of the stimulus artifact vector direction of greater than 90 degrees in either the frontal or horizontal planes. Rapid screening of the routine ECG is an effective means of detecting catheter displacement, with or without loss of pacing.