It was reported that this patient was implanted with a pacemaker system.One day post operative, the field representative went to perform a pre-discharge check and noted right atrial (ra) and right ventricular (rv) thresholds were higher than at implant.Impedance and amplitudes were within range.The device was programmed to unipolar, and thresholds were checked again and this time there was loss of capture on both leads.A chest x-ray was performed and there was suspected lead migration/dislodgement and perforation for both leads.The physician decided to perform a lead extraction and use passive fixed leads.A lead revision procedure was performed, and the leads were removed.When they connected the new leads to the device there was a drop in r wave amplitudes therefore, the rv lead was re-positioned.This time they had good measurements from the pacing system analyzer (psa) and from the device, so they began closing the pocket.On the sub-q layer of sutures, there was an increase instance of failed av search so lead tests were ran again.It was noted there was an acute rise in rv thresholds in bipolar and again loss of capture in unipolar.The device was removed from the pocket, and they tested ra and rv thresholds using the psa and they were acceptable measurements.The leads were plugged back in the original device used from implant and there were normal measurements in bipolar however, abnormal measurements when in unipolar.The ra had loss of capture and rv had high thresholds.Subsequently, the device was removed, and a new device was implanted.Lead testing was performed, and all lead measurements were within range.At pre-discharge they confirmed again all measurements were normal when programmed in bipolar and unipolar.No additional adverse patient effects were reported.
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