© 1999 by European Society of Cardiology
Bipolar atrial sensing thresholds in sinus rhythm and atrial tachyarrhythmias
A comparative analysis in patients with DDDR pacemakers
Department of Cardiology, Kerckhoff Clinic Bad Nauheim, Germany
Automatic mode switching (AMS) function in dual chamber pacemakers depends on adequate detection of atrial tachyarrhythmias. There are few data on showing how intra-operative atrial signal amplititude during sinus rhythm can predict atrial tachyarrhythmias after pacemaker implantation. In 43 patients undergoing DDDR pacemaker implantation and atrioventricular nodal ablation for the treatment of drug-refractory paroxysmal atrial fibrillation, atrial sensing thresholds during sinus rhythm and during induced atrial tachyarrhythmias (24–48 h after device implantation) were analysed. Five different DDDR pacemaker systems were implanted (Chorus 7034|Pt, Ela Medical n=13; Meta DDDR 1254|Pt, Telectronics Pacing Systems n=12; Vigor DR 1230|Pt, Guidant n=6; Trilogy DR 2364|Pt, Pacesetter, n=2; Kappa DR 401|Pt, Medtronic USA n=10). Every patient received a steroid-eluting, screw-in, bipolar atrial lead (Medtronic, Capsure-Fix 4068|Pt). The mean P wave amplitude during implantation was 3·91±1·14 mV. The mean atrial sensing threshold during sinus rhythm and during all modes of induced atrial tachy-arrhythmias was 3·35±1·0 mV, and 1·52±0·92 mV, respectively (P<0·001). Atrial fibrillation was induced in 36 patients. The mean sensing threshold during sinus rhythm in this patient group was 3·39±1·01 mV, the mean sensing threshold during atrial fibrillation was 1·27±0·56 mV, reflecting a 63% reduction of sensing threshold compared with sinus rhythm (P<0·001). Atrial flutter was induced in seven patients. The mean sensing threshold during sinus rhythm was 2·92±1·19 mV, the mean sensing threshold during atrial flutter was 2·79±1·26 mV, reflecting a reduction of 5% (ns) compared with sinus rhythm. Atrial sensing thresholds during sinus rhythm were significantly correlated with sensing thresholds during atrial tachyarrhythmias (r=0·44;P<0·002), but there were significant variations in intra-individual results. The reduction of atrial sensing thresholds between sinus rhythm and induced atrial tachyarrhythmias ranged from 30% to 82%.
CONCLUSION: Bipolar atrial sensing thresholds during sinus rhythm are correlated with sensing thresholds during atrial tachyarrhythmias, but there is a large degree of variance in individual patients. A 4:1 to 5:1 atrial sensing safety margin based on sensing threshold during sinus rhythm is a predictor for adequate postoperative detection of atrial tachyarrhythmias and the function of AMS devices.
Key Words: Bipolar atrial sensing thresholds, automatic mode switch, atrial tachyarrhythmias, dual chamber pacing
Correspondence: Jörg Neuzner, Department of Cardiology, Kerckhoff Clinic, Beneke Strasse 2–8, 61231 Bad Nauheim, Germany.
[1] Gross JN, Moser S, Benedek ZM, Andrews C, Furman S. DDD pacing mode survival in patients with a dual-chamber pacemaker. J Am Coll Cardiol 1992; 19: 1536–1541.[Abstract]
[2] Ibrahim B, Sanderson JE, Wright B, Palmer R. Dual chamber pacing: how many patients remain in DDD mode over long term. Br Heart J 1995; 74: 76–79.
[3] DenDulk K, Dijkman B, Pieterse M, Wellens H. Initial experience with mode switching in a dual sensor, dual chamber pacemaker in patients with paroxysmal atrial tachyarrhythmias. PACE 1994; 17: 1900–1907.
[4] Mond HG and Barold SS. Dual chamber, rate adaptive pacing in patients with paroxysmal supraventricular tachyarrhythmias: protective measures for rate control. PACE 1993; 16: 2168–2185.
[5] Kamalvand K, Tan K, Kotsakis A, Bucknall C, Sulke N. Is mode switching beneficial? A randomized study in patients with paroxysmal atrial tachyarrhythmias. J Am Coll Cardiol 1997; 30: 496–504.[Abstract]
[6] Kay GN, Ellenbogen KA, Giudici M. The ablate and pace trial: a prospective study of catheter ablation of the AV junction system and permanent pacemaker implantation for treatmentof atrial fibrillation. J Intervent Cardiac Electrophysiol 1998; 2: 121–135.[CrossRef][Web of Science][Medline]
[7] Fitzpatrick AP, Kourouyan HD, Siu A. Quality of life and outcomes after radiofrequency His-bundle catheter ablation and permanent pacemaker implantation. Am Heart J 1996; 131: 499–507.[CrossRef][Web of Science][Medline]
[8] Palma EC, Kedarnath V, Vankawalia V. Effect of varying atrial sensitivy, AV interval, and detection algorithm on automatic mode switching. PACE 1996; 19: 1734–1739.
[9] Ricci R, Puglisi A, Azzolini P. Reliability of a new algorithm for automatic mode switching from DDDR to DDIR pacing mode in sinus node disease patients with chronotropic incompetence and recurrent paroxysmal atrial fibrillation. PACE 1996; 19: 1719–1723.
[10] Langberg JJ, Chin MC, Rosenqvist M. Catheter ablation of the atrioventricular junction with radiofrequency energy. Circulation 1989; 80: 1527–1535.
[11] Wood MA, Moskovljevic P, Stambler B, Ellenbogen KA. Comparison of bipolar atrial electrogram amplitude in sinus rhythm, atrial fibrillation, and atrial flutter. PACE 1996; 19: 150–156.
[12] Kay GN and Bubien RS. Algorithms for management of atrial fibrillation in patients with dual-chamber pacing systems. In Rosenqvist M (Ed.). Cardiac Pacing New Advances 1997; London W.B. Saunders Company Ltd pp. 61–82.
[13] Paydak H, Kall JG, Burke MC. Atrial fibrillation after radiofrequency ablation of type 1 atrial flutter. Time to onset, determinants, and clinical course. Circulation 1998; 98: 315–322.
[14] Wijffels MCEG, Kirchhof CJHJ, Durland R, Allessie MA. Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation 1995; 92: 1954–1968.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. Schmidt, S. Asbach, O. Schweika, M. Zehender, C. Bode, and T. S. Faber Atrial fibrillation reduces the atrial impedance amplitude during cardiac cycle: a novel detection algorithm to improve recognition of atrial fibrillation in pacemaker patients Europace, September 1, 2007; 9(9): 812 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schuchert, M. A. Aydin, C. Israel, G. Gaby, and V. Paul Atrial pacing and sensing characteristics in heart failure patients undergoing cardiac resynchronization therapy Europace, January 1, 2005; 7(2): 165 - 169. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||