?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Management+of+the+Patient+with+an+Acute+Massive+Rise+in+the+Capture+Threshold&rft.creator=Levine%2C+Paul+A.&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=Since+the+introduction+of+steroid+eluting+electrodes%2C+the+incidence+of+an+early+massive+rise+in+the+capture+threshold+that+either+exceeds+or+threatens+to+exceed+the+programmed+output+of+the+pacemaker+has+declined+but+has+not+totally+disappeared1++If+a+persistent+or+massive+threshold+rise+is+encountered+in+the+days+to+months+post-implant%2C+one+consideration+is+microinstability+of+the+lead.++In+this+setting%2C+there+may+be+a+change+in+the+morphology+of+the+pacemaker+evoked+depolarization+on+the+ECG+or+a+change+in+the+physical+location+of+the+lead+as+assessed+with+a+chest+x-ray.++Another+marker+is+fluctuations+in+the+capture+threshold+on+repeated+assessments+at+the+same+office+or+clinic+visit.+The+options+for+this+problem+include+an+operative+procedure+to+reposition+or+replace+the+lead+or+to+closely+observe+the+patient+hoping+that+the+lead+settles+into+a+secure+location.+Another+potential+totally+reversible+cause+is+the+introduction+of+an+new+medication+or+herb.+If+the+possible+explanations+for+threshold+increase+cited+above+have+been+excluded+and+the+high+capture+threshold+is+believed+to+be+due+to+lead+maturation%2C+increasing+the+output+or+possible+lead+replacement+or+repositioning+have+been+the+usual+options.%0A&rft.publisher=Indian+Pacing+and+Electrophysiology+Group&rft.contributor=Singh%2C+Balbir&rft.contributor=Lokhandwala%2C+Yash&rft.contributor=Francis%2C+Johnson&rft.contributor=Gupta%2C+Anup&rft.date=2001-01&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F4330%2F1%2Flevine.htm&rft.identifier=++Levine%2C+Paul+A.++(2001)+Management+of+the+Patient+with+an+Acute+Massive+Rise+in+the+Capture+Threshold.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4330%2F