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Europace 1999 1(2):131-134; doi:10.1053/eupc.1998.0030
© 1999 by European Society of Cardiology
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Placement of atrial pacing leads during atrial fibrillation

Feasibility and subsequent lead performance

H. J. Marshall, M. J. Griffith and M. D. Gammage

University Department of Cardiovascular Medicine, Queen Elizabeth Hospital Birmingham, U.K

AIMS: To assess the feasibility of placing permanent atrial pacing leads during atrial fibrillation (AF) and whether such leads function satisfactorily.

METHODS AND RESULTS: Prospective study of 17 consecutive patients in whom permanent atrial leads were positioned during an episode of paroxysmal AF. Fluoroscopic pos-ition (‘figure of 8’ or side-to-side movement and anterior position in RAO projection), lead impedance (>300 but <1000 ohms) and intracardiac electrogram (average peak to peak amplitude >1 mV) were used to define an acceptable lead position. At 8 weeks post implant we measured: pulse duration pacing threshold at 5 V; lead impedance at 5 V and 0·5 ms; intracardiac electrogram (EGM) signal amplitude. At the end of the study we reviewed patients to establish whether AF had become permanent. In all patients, follow-up demonstrated satisfactory lead function. All leads had impedances between 300 and 1000 ohms. Pacing thresholds were all <0·1 ms at 5 V. Mean atrial EGM amplitude seen in sinus rhythm was 3·3 mV (range 1·2–8·4); in patients where all follow-up was in AF it was 2·1 mV (range 1·5–2·5). Nine patients (53%) developed permanent AF.

CONCLUSION: Placing atrial leads during AF is feasible using the technique described. However, some patients progress to chronic AF, eliminating the benefits of atrial pacing.

Key Words: Atrial fibrillation, permanent pacing leads, implantation technique, atrial electrograms, atrial sensing by pacemakers

Correspondence: Dr H. J. Marshall, University Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, U.K


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