Pacemaker crosstalk

Pacemaker crosstalk results when pacemaker generated electrical event in one chamber is sensed by the lead in another chamber, resulting in inappropriate inhibition of pacing artifact in the second chamber.

Cause
Crosstalk occurs only in dual chamber or biventricular pacemakers, though it rarely seen more recent models of dual chamber pacemakers due to ventricular blanking period, which coincides with the atrial stimulus to prevent ventricular channel oversensing of atrial output, along with bipolar leads with a smaller pacing spike, and steroid eluting leads with a lower pacing threshold. Crosstalk is more common in unipolar systems due to larger pacing spike. Crosstalk is sometimes referred to as known crosstalk inhibition, far-field sensing, or self-inhibition. In some cases, crosstalk can occur in the pulse generator circuit itself, though more common causes include atrial lead dislodgement into the ventricle, ventricular lead dislodgement into the atrium, high atrial output current, high ventricular sensitivity, and short ventricular blanking period.

Treatment
In general, the treatment of crosstalk includes decreasing atrial pacing output, decreasing atrial pulse width, decreasing ventricular sensitivity, increasing the ventricular blanking period, activating ventricular safety pacing, and new atrial lead implant if insulation failure mandates unipolar programming.