Europace

Europace 2003 5(2):175-183; doi:10.1053/eupc.2002.0299
© 2003 by European Society of Cardiology

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Stability of far field R wave signals in different conditions

F. J. C. Cools¹, R. R. C. van Twembeke², J. Backers² and G. A. Verpooten³

¹AZ KLINA, Dep. of Cardiology Augustijnslei 100, 2930 Brasschaat, Belgium; ²Univ. Hospital Antwerp, Dep. of Nephrology Wilrijkstraat 10, 2650, Edegem, Belgium; ³Biotronik Belgium Plejadenlaan 19, 1200, Brussel, Belgium

AIMS: The presence of far field R wave sensing (FFRS) is usually evaluated in patients with dual chamber pacemakers in supine position. To check if this approach is valid, we tested whether FFRS is consistent both in terms of amplitude threshold and timing characteristics in different daily life conditions.

METHODS AND RESULTS: In 42 patients with a DDD pacemaker, the presence, amplitude threshold and timing parameters of FFRS were therefore determined, with patients supine, standing and at peak exercise. Measurements were made of paced and sensed R waves, in unipolar and bipolar sensing configurations (at peak exercise only paced R waves and bipolar sensing).

After paced R waves (bipolar sensing) amplitude thresholds/time of FFRS after Vpace were 0·32±0·18 mV/119–139 ms (supine), 0·32±0·16 mV/114–130 ms (upright) and 0·27±0·13 mV/121–136 ms (exercise) — with unipolar sensing, this was 0·49±0·27 mV/101–150 ms (supine), 0·51±0·29 mV/100–144 ms (upright).

After sensed R waves (bipolar sensing) amplitude thresholds/time of FFRS after Vsense were 0·27±0·18 mV/24–42 ms (supine), 0·29±0·16 mV/18 to 41 ms (upright) — with unipolar sensing, thresholds were 0·59±0·32 mV/3–50 ms (supine), 0·59±0·36 mV/2–58 ms (upright).

CONCLUSION: given the lower FFRS thresholds with bipolar sensing, bipolar sensing is superior in avoiding FFRS compared with unipolar sensing. No differences were found in terms of amplitude thresholds and timing characteristics with patients supine, standing and at peak exercise. Thus, measurements made in the supine position are basically sufficient to predict the presence/absence of FFRS under different conditions.

Key Words: Oversensing, far-field, exercise, upright

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^_*Correspondence: Frank Cools, AZ KLINA, Dep. of Cardiology, Augustijnslei 100, 2930 Brasschaat Belgium. Tel.: 32-3-6505144; Fax: 32-3-2189099; E-mail: frankcools{at}skynet.be; Univ. Hospital Antwerp, Dep. of Nephrology, Wilrijkstraat 10, 2650 Edegem, Belgium; Biotronik Belgium, Plejadenlaan 19, 1200 Brussel, Belgium.

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