Effects of muscle potential depression and muscle stimulation caused by different insulation coating configurations on cardiac pacemakers.

Insulation coating was added to the external pacemaker surface to prevent unnecessary electric current leakage to the periphery because the pulse generator body is used as an anode in unipolar pacing. However, a model without insulation coating has recently been used, so we studied the effects on muscle potential inhibition and muscle stimulation of pacemakers in unipolar pacing with different parts of the pacemaker body coated with insulation. Case comparisons were made for the following models: insulated except for the center of one side (33, group C), insulated except for the peripheral zone (10, group E), and noncoated models (11, group N). The muscle detection threshold voltage, muscle detection threshold pulse duration, muscle potential sensing threshold (MP), and lead resistance were measured. A comparison was made of the amount of energy (En) needed to reach the muscle stimulation threshold. For MP values, there was no significant statistical difference between group C and E, whereas a significant difference was present between group C and N and between group E and N. For En values, there was a significant difference between group C and E and between group C and N, but there was no significant difference between group E and N. The muscle potential sensing threshold dose not have a change in group E and much muscle stimulation energy is needed. The muscle potential sensing threshold was low in group N, requiring much muscle stimulation energy. Based on these results, it is usually not necessary to coat the pacemaker with insulation for unipolar pacing.