Programmable pacemakers: technical features and clinical applications.

With each new generation of pacing systems, there appears to be a renewed interest in providing the physician with something else to program. Many of the aforementioned parameters that have been programmable options in single-chamber devices are now selectively available in two-channel units. A growing interest in telemetry that offers the physician a means of electronic dialogue with the pulse generator to assess existing parameters, battery voltage, and hermeticity, and provides transmission of such data as an intracavitary ECG, arrhythmia monitoring, and historical data on the patient are variations of programmability soon to be increasingly available. A major responsibility is arising for the physician who reprograms an implanted pacemaker system to maintain accurate records and ensure that the patient and other physicians are aware of any new adjustments. Failure to do so risks needless removal of otherwise properly functioning devices by other physicians with whom the patient may interact. Thus, while programmability has widened the horizons for noninvasive adjustment of existing pacemaker performance, it has also markedly complicated the record-keeping responsibilities of the monitoring physician.