Increase of Ventricular Excitability Threshold by Hyperpotassemia

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Abstract
Hyperpotassemia increases excitability threshold of the ventricular myocardium and may be responsible for the failure of the implanted pacemakers. The following observations support this hypothesis: (1) A patient with hyperpotassemia became unresponsive to stimulation by a nondefective, implanted pacemaker. (2) In another patient with a transvenous pacemaker, excitability threshold increased from less than one volt (v) to more than six v when plasma potassium concentration was raised from 4.0 to 7.1 mEq/liter. (3) In dogs, ventricular excitability threshold increased with increasing potassium concentration. These observations suggest that in patients with implanted pacemakers hyperpotassemia must be prevented and promptly treated.

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