© 1999 by European Society of Cardiology
Placement of atrial pacing leads during atrial fibrillation
Feasibility and subsequent lead performance
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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