LONG-TERM STABILITY OF P-WAVE SENSING IN SINGLE-LEAD VDDR PACING - CLINICAL VERSUS SUBCLINICAL ATRIAL UNDERSENSING

被引:28
作者
LAU, CP
TAI, YT
LEUNG, SK
LEUNG, WH
CHUNG, FLW
LEE, ISF
机构
[1] Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital
来源
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY | 1994年 / 17卷 / 11期
关键词
SINGLE-PASS LEAD VDDR PACING; ATRIAL SENSING;
D O I
10.1111/j.1540-8159.1994.tb03761.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Optimal function of a single lead P wave synchronous rate adaptive ventricular pacing system (VDDR) requires reliable P wave sensing over time and during daily activities. The stability of P wave sensing and the incidence of sensitivity reprogramming in a single pass lead with a diagonally arranged bipole wa:; assessed in 30 patients with complete atrioventricular block over a follow-up period of 12 +/- 1 months (range 6 months to 3 years). Atrial sensing was assessed during clinic visits, by physical maneuvers (postural changes, breathing, Valsalva maneuver, walking and isometric exercise), maximum treadmill exercise and Holter recordings. P wave amplitude at implantation was 1.21 +/- 0.09 (0.5-3.6) mV, and the atrial sensing threshold remained stable over the entire period of follow-up. Using an atrial sensitivity based on twice the sensing threshold at 1 month, P wave undersensing was found in 2, 4, 3, and 7 patients during clinic visit, physical maneuvers, exercise, and Holter recordings, respectively. Atrial sensitivity reprogramming was performed in three patients based on the correction of undersensing during physical maneuvers. Although eight patients had atrial undersensing on Holter recordings, the number of undersensed P waves was small (total 101 beats or 0.013% +/- 0.001% of total ventricular beats) and no patient was symptomatic. One patient had intermittent atrial undersensing at the highest sensitivity, but the VDDR mode was still functional most of the time. No patient had myopotential interference at the programmed sensitivity. One patient developed chronic atrial fibrillation and was programmed to the VVIR mode. Thus, single lead VDDR pacing is a stable pacing mode in 97% of patients. Because of the large variability of P wave amplitude, the use of a sensitivity margin at least three times the atrial sensitivity threshold will maximize atrial sensing and minimize the need for atrial sensitivity reprogramming (1/30 patients). Physical maneuvers and exercise tests are effective means for rapid assessment of the adequacy of P wave sensing.
引用
收藏
页码:1849 / 1853
页数:5
相关论文
共 20 条
[1]  
ANTONIOLI GE, 1993, NEW PERSPECTIVES CAR, V3, P359
[2]  
ANTONIOLI GE, 1980, G ITAL CARDIOL, V10, P676
[3]   SENSING AND PACING WITH FLOATING ELECTRODES IN THE RIGHT ATRIUM AND RIGHT ATRIAL APPENDAGE [J].
AUBERT, AE ;
GOLDREYER, BN ;
WYMAN, MG ;
ECTOR, H ;
DENYS, BG ;
DEGEEST, H .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1987, 9 (02) :308-315
[4]   TOWARD OPTIMIZING THE DETECTION OF ATRIAL DEPOLARIZATION WITH FLOATING BIPOLAR ELECTRODES [J].
BROWNLEE, RR .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1989, 12 (03) :431-442
[5]  
BRUNEKREEFT W, 1994, VITATRON MED BV VITA, V1, P1
[6]  
CHAMBERLAIN DA, 1973, BRIT HEART J, V35, P559
[7]   CLINICAL-EVALUATION OF VDD PACING WITH A UNIPOLAR SINGLE-PASS LEAD [J].
CORNACCHIA, D ;
FABBRI, M ;
MARESTA, A ;
GRASSI, G ;
VAIANI, P .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1989, 12 (04) :604-618
[8]   EUROPEAN MULTICENTER PROSPECTIVE FOLLOW-UP-STUDY OF 1,002 IMPLANTS OF A SINGLE LEAD VDD PACING SYSTEM [J].
CRICK, JCP .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1991, 14 (11) :1742-1744
[9]  
CURRY PVL, 1978, LANCET, V2, P757
[10]   A MULTICENTER EVALUATION OF A SINGLE-PASS LEAD VDD PACING SYSTEM [J].
CURZIO, G .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1991, 14 (03) :434-442