© 2002 by European Society of Cardiology
REGULAR ARTICLES
Single-lead VDD-pacing system incorporating high impedance stimulation: a multicentre study
1II. Medical Clinic, University Mainz Germany; 2St Josef-Hospital, Ruhr-University Bochum, Germany; 3Hospital Virgen del Rocio Sevilla, Spain; 4Guidant Inc. Brussels Belgium; 5Ospedale Miulli, Divisione di Cardiologia, Aquaviva delle Fonti Italy; 6CHU Henri Mondor, Département de Cardiologie Créteil, France; 7University Clinic Otto-von-Guericke Magdeburg, Germany; 8Ospedale Civile, Divisione de Cardiologia Mirano, Italy; 9Patras University Hospital, Division of Cardiology Patras, Greece; 10Hôpital Universitaire Dupuytren Limoges, France; 11Hospital General Universitario, Cardiology Unit Alicante, Spain; 12Medisch Spectrum Twente, Cardiologie Enschede, Netherlands
Manuscript submitted 21 June 2000. Accepted after revision 10 January 2002.
Correspondence: Bernd Nowak, MD, Cardiovascular Center Bethanien, Im Prüfling 23, D-60389 Frankfurt a.M., Germany. E-mail: nowak{at}ccb.de
Key Words: VDD-pacing system, high impedance stimulation, atrial sensing, AV synchrony
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Aim |
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 Top Aim Methods and ResultsConclusionReferences |
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The purpose of this study was to evaluate the performance of a new VDD pacing system incorporating a high impedance, single-pass VDD lead. The new lead is a bipolar, steroid-eluting, high impedance lead with a full-ring atrial dipole.
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Methods and Results |
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TopAimMethods and ResultsConclusionReferences |
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The system was implanted in 46 patients with high degree atrioventricular (AV) block. Patients were followed at pre-discharge, 6 weeks, and 3 months. The mean measured P-wave amplitude was stable, with values between 1·18 and 1·43 mV. Atrial sensing was reliable during short-term evaluation at rest and in the sitting position, with AV-synchronous stimulation between 98·79±6·90% and 99·73±1·47%. Holter recordings after 6 weeks demonstrated AV-synchronous stimulation in 99·57±1·03% of all P-waves. Lead impedance was stable during follow-up, with mean values between 1000 and 1167
. Mean ventricular pacing thresholds (at 0·5 ms) were 0·47 V at implant, 0·49 V at pre-discharge, 0·74 V at 6 weeks, and 0·72 V at 3 months. R-wave amplitude remained stable between 14·9 and 16·7 mV during follow-up. |
Conclusion |
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TopAimMethods and ResultsConclusionReferences |
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This new single-pass VDD lead system provided reliable atrial sensing and stable high impedance stimulation during a 3-month follow-up period.
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References |
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TopAimMethods and ResultsConclusionReferences |
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[1] ACC/AHA Guidelines for implantation of cardiac pacemakers and antiarrhythmia devices. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 1998; 31: 1175–1209.
[2] Lau CP, Tai YT, Leung SK, Leung WH, Chung FLW, Lee ISF. Long-term stability of P wave sensing in single lead VDDR pacing: Clinical versus subclinical atrial undersensing. Pacing Clin Electrophysiol 1994; 17: 1849–1853.[Medline]
[3] Nowak B, Middeldorf T, Voigtländer T, et al. How reliable is atrial sensing in single-lead VDD stimulation: comparison of three systems. Pacing Clin Electrophysiol 1998; 21: 2226–2231.[Medline]
[4] Faerestrand S and Ohm OJ. Atrial synchronous ventricular pacing with a single lead: reliability of atrial sensing during physical activities, and long-term stability of atrial sensing. Pacing Clin Electrophysiol 1998; 21: 271–276.[Medline]
[5] Rey JL, Tribouilloy C, Elghelbazouri F, Otmani A. Single-lead VDD pacing: long-term experience with four different systems. Am Heart J 1998; 135: 1036–1039.[CrossRef][Web of Science][Medline]
[6] Schuchert A, Malinowski K, Seidl KH, Hilbel T, Meinertz T, Brachmann J. The intraoperative benefits of single-lead VDD in comparison to DDD pacing. Pacing Clin Electrophysiol 1999; 22: A109 (Abstract).
[7] Rey JL, Anzid A, Otmani A, Tribouilloy C, Hermida JS, Leborgne L. Comparison between single lead VDD and conventional DDD pacing systems for treatment of atrio-ventricular block. Heartweb 1998; 4: Article No. 98120009.
[8] Nowak B and Voigtländer T. Operative management in a prospective randomized study comparing DDD- and VDD-stimulation for high degree AV-block: the DAVE-study (DDD And VDD Evaluation). Arch mal coeur 1998; 91: 332.
[9] Wiegand UKH, Schneider R, Bode F, Giannitsis E, Diederich KW, Potratz J. Does the implantation of single-lead VDD-devices reduce the complication rate in dual chamber pacemakers? Pacing Clin Electrophysiol 1997; 20: 1563.
[10] Moracchini PV, Cornacchia D, Bernasconi M, et al. High impedance low energy pacing leads: long-term results with a very small surface area steroid-eluting lead compared to three conventional electrodes. Pacing Clin Electrophysiol 1999; 22: 326–334.[Medline]
[11] Danilovic D, Ohm OJ, Breivik K. Clinical use of low output settings in 1·2-mm2 steroid eluting electrode: three years of experience. Pacing Clin Electrophysiol 1998; 21: 2606–2615.[Medline]
[12] Ellenbogen KA, Wood MA, Gilligan DM, Zmijewski M, Mans D. Steroid eluting high impedance pacing leads decrease short and long term current drain: results from a multicenter clinical trial. Pacing Clin Electrophysiol 1999; 22: 39–48.[Medline]
[13] Fröhlig G, Bolz A, Ströbel J, et al. A fractally coated, 1·3 mm2 high impedance pacing electrode. Pacing Clin Electrophysiol 1998; 21: 1239–1246.[Medline]
[14] Fogel R, Pirzada F, Casavant D, et al. Initial experience with 1·5-mm2 high impedance, steroid-eluting pacing electrodes. Pacing Clin Electrophysiol 1996; 19: 188–196.[Medline]
[15] Irnich W. Paradigm shift in lead design. Pacing Clin Electrophysiol 1999; 22: 1321–1332.[CrossRef][Medline]
[16] Webb CR, Sample RD, Hepp W. Initial clinical experience with a steroid eluting, high impedance endocardial pacing lead. Arch mal coeur 1998; 91: 132.
[17] Nowak B, Voigtländer T, Liebrich A, Himmrich E, Möller B, Meyer J. A simple method for preoperative assessment of the best fitting electrode length in single lead VDD pacing. Pacing Clin Electrophysiol 1996; 19: 1346–1350.[Medline]
[18] Lewalter T, MacCarter D, Jung W, et al. The "Low Intensity Treadmill Exercise" protocol for appropriate rate adaptive programming of minute ventilation controlled pacemakers. Pacing Clin Electrophysiol 1995; 18: 1374–1387.[Medline]
[19] Antonioli GE. Single lead atrial synchronous ventricular pacing: a dream come true. Pacing Clin Electrophysiol 1994; 17: 1531–1547.[Medline]
[20] Ansani L, Percoco GF, Guardigli G, Toselli T, Antonioli GE. Long-term reliability of single lead atrial synchronous pacing systems using closely spaced atrial dipoles: five year experience. Pacing Clin Electrophysiol 1994; 17: 1865–1869.[CrossRef][Medline]
[21] Lau CP, Leung SK, Lee ISF. Comparative evaluation of acute and long-term clinical performance of two single lead atrial synchronous ventricular (VDD) pacemakers: diagonally arranged bipolar versus closely spaced bipolar ring electrodes. Pacing Clin Electrophysiol 1996; 19: 1574–1581.[Medline]
[22] Naegeli B, Osswald S, Pfisterer M, Burkart F. VDD(R) pacing: short- and long-term stability of atrial sensing with a single lead system. Pacing Clin Electrophysiol 1996; 19: 455–464.[CrossRef][Medline]
[23] Papouchado M and Pitts Crick JC. Evolution of atrial signals from a singe lead VDD pacemaker. Pacing Clin Electrophysiol 1996; 19: 1772–1776.[Medline]
[24] Tesorieri MC, Moracchini PV, Giuliani M, et al. Eight year clinical experience with the Medico Phymos system. In Oto A (Ed.). 7th European Symposium on cardiac pacing 1995; Bologna Monduzzi Editore pp. 317–320.
[25] Ovsyshcher IE, Katz A, Rosenheck S, Erdman S, Bondy C. Single lead VDD pacing: multicenter study. Pacing Clin Electrophysiol 1996; 17: 1768–1771.
[26] Wiegand UKH, Schneider R, Bode F, Brandes A, Diederich KW, Potratz J. Long-term atrioventricular synchrony in a single-lead VDD pacemaker system: comparison with a DDD-pacemaker in respect of their Holter data-legends. Eur J Card Pacing Electrophysiol 1997; 7: 183–190.
[27] Gessman L, White M, Ghaly N, et al. US experience with the AddVent VDD(R) pacing system. Pacing Clin Electrophysiol 1996; 19: 1764–1767.[Medline]
[28] Steinbach K. Experience with the system Dromos. Herzschr Elektrophys 1996; 7: 46–54.
[29] Scherer M, Ezziddin K, Klesius A, et al. Extension of pulse generator longevity by use of high impedance ventricular leads. Pacing Clin Electrophysiol 2001; 24: 206–211.[Medline]
[30] Mond HG, Hua W, Wang CC. Atrial pacing leads: the clinical contribution of steroid elution. Pacing Clin Electrophysiol 1995; 18: 1601–1608.[Medline]
[31] Moracchini PV, Tesorieri MC, Giuliani M, et al. Intrapatient comparison of atrial and ventricular sensing, pacing threshold, and impedance: benefits with steroid-eluting leads. Pacing Clin Electrophysiol 1996; 19: 1482–1487.[CrossRef][Medline]
[32] Danilovic D, Breivik K, Hoff PI, Ohm OJ. Clinical performance of steroid-eluting pacing leads with 1·2 mm2 electrodes. Pacing Clin Electrophysiol 1997; 20: 2799–2809.[Medline]
[33] Physician's Manual. Selute® PicotipTM Steroid-eluting endocardial leads, Guidant Corporation, Cardiac Pacemaker (CPI), St. Paul, MN, U.S.A.
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