Low pacing impedance in pacemaker patients with cardiac diseases

Background and aim of the study: As increasing impedance of the pacing impulse decreases pacing current, high pacing impedance lowers pacing current and subsequently prolongs pacemaker longevity. The present assumption of a standard 500 ohms impedance disregards interindividual differences. In the present study, the interindividual range of pacing impedance was assessed at implantation. Additionally clinical parameters of patients with low pacing impedance were compared to those of patients with high values. Patients and methods: The same lead and the same pacemaker (CapSure VDD; Thera VDD: Medtronic) were implanted in 126 patients (79 men, 47 women, mean age 65 +/- 16 years). Patients with an impedance below or similar to the median were compared to patients with an impedance above the median in respect to clinical (age, gender, arterial hypertension, cardiac diseases such as coronary heart disease, valvular heart disease, cardiomyopathy) and electrical parameters (pacing threshold at 0.5 ms pulse duration, R-wave amplitude). Results: Mean impedance was 687 +/- 121 ohms with a range from 333 to 1040 ohms and a median of 670 ohms. 64 patients had an impedance less than or equal to 670 ohms and 62 patients >670 ohms. Mean age, gender and the occurrence of arterial hypertension were similar in the two groups. Cardiac diseases occurred significantly (P < 0.01) more often in patients with lower (n = 23) than with higher impedance (n = 9). Intraoperative pacing thresholds and R-wave amplitudes were not different between the two groups. Conclusions: The range of pacing impedance was 707 ohms for the studied lead. Under consideration of permanent pacing with 2.5 V pulse amplitude and 0.5 ms pulse duration this would vary expected longevity of the implanted pacemaker from 7.8 to 9.3 years. Patients with lower impedance more often had cardiac diseases than patients with higher impedance.