By Charles J. Love
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Extra resources for Cardiac Pacemakers and Defibrillators, 2nd Edition
Activity / Vibration This method of adjusting the pacing rate by using a sensor was the first to be approved by the United States Food and Drug Administration. A piezoelectric crystal that generates an electrical signal when vibrated or stressed is bonded to the inside of the pacemaker. When the patient walks, the vibrations from the body are transmitted through the pacemaker causing an electrical output to be generated from the crystal (Fig. 1). These vibrations usually occur during and in proportion to the patient’s level of physical Fig.
1). Under most circumstances an intrinsic QRS sensed before the end of the AVI will inhibit the ventricular output and the timing cycle will be reset for the next atrial output (a new atrial escape interval will start; see below). The intrinsic event may be a normally conducted QRS due to intact AV node function or it may be a PVC or premature junctional beat. Once a P-wave is sensed or an atrial stimulus is delivered, atrial sensing for the purpose of tracking P-waves is turned off until after the ventricular event occurs and the atrial blanking and refractory periods have terminated.
The AVI following a sensed P-wave is allowed to be shorter than the AVI following a paced P-wave (Fig. 2). Some devices have a fixed nonprogrammable setting in the range of 25-50 msec. Other devices Cardiac Pacemakers and Defibrillators, Second Edition. Charles J. Love. ©2006 Landes Bioscience. 4 36 Cardiac Pacemakers and Defibrillators Fig. 1. AV interval: The period of time in milliseconds between a paced or sensed atrial event until the paced ventricular event. If a sensed ventricular event occurs before the end of the AVI, the ventricular output will be withheld.