Group purchasing organizations: optimizing cardiac device selection, therapy delivery, and fiscal responsibility.

Group purchasing organizations (GPOs) have played a major role in supporting health care delivery in recent years as the healthcare industry has faced stronger economic pressures. Consequently, a position statement was drafted to act as a guideline for a GPO in creating a fiscally responsible, yet unrestricted environment for physicians to select the most appropriate cardiac device for their patients. This cardiac device selection guideline is to be implemented in hundreds of member hospitals but may be of use in non-member hospitals as well.

Electromagnetic interference in cardiac rhythm management devices.

Clinicians caring for cardiac device patients with implanted pacemakers or cardioverter defibrillators (ICDs) are frequently asked questions by their patients concerning electromagnetic interference (EMI) sources and the devices. EMI may be radiated or conducted and may be present in many different forms including (but not limited to) radiofrequency waves, microwaves, ionizing radiation, acoustic radiation, static and pulsed magnetic fields, and electric currents. Manufacturers have done an exemplary job of interference protection with device features such as titanium casing, signal filtering, interference rejection circuits, feedthrough capacitors, noise reversion function, and programmable parameters.

No output or runaway?

A 75-year-old male was implanted with a Telectronics Meta DDDR model 1250 pacemaker 47 months ago. The patient was evaluated in-office for symptomatic complaints of dizziness, palpitations, and "too slow or too fast" pulse rates. Upon examination, the device displayed sudden no output manifestations for which the device had been recalled.

Activation times for "emergency backup" programs.

A bench study was performed on 42 different pulse generators (PGs) to evaluate the time required to actuate and "emergency backup" (EBU) program. PGs were programmed to loss of capture before the EBU programming key was activated. Activation times for the EBU pause were measured on an ECG strip from the first noncaptured beat to the first recaptured beat while the total pause was measured between the two captured beats.