Document Detail


Atrial lead location at the Bachmann's bundle region results in a low incidence of far field R-wave sensing.
MedLine Citation:
PMID:  18192341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The aim of the study was to investigate far field R-wave sensing (FFRS) rate and characteristics at different right atrial (RA) positions in patients treated with multisite atrial pacing, with the RA lead implanted at the Bachmann's bundle (BB) area in 69 patients, in comparison to RA appendage (RAA) in 70 patients. METHODS AND RESULTS: All measurements were done during sinus rhythm in supine patients, with unipolar (UP) and bipolar (BP) sensing configuration. The presence, amplitude threshold (FFRS trsh) and FFRS timing were determined. Sensing safety margin was defined as the ratio of sensed P-wave vs. FFRS trsh, for both the minimal (Pmin) and the mean (Pmean) P-wave amplitude. At both atrial locations BP sensing was superior to UP in FFRS rejection (P < 0.0001). At 0.5 mV sensitivity level (BP) FFRS occurred in 1% of patients at the BB site vs. 11% at the RAA (P = 0.01). FFRS trsh (BP) was 0.2 +/- 0.1 mV at the BB vs. 0.4 +/- 0.3 mV in the RAA position (P < 0.0001). Sensing safety margin, when determined for the Pmin amplitude was > or =5 in 99% of patients from the BB group, in comparison to 66% of RAA patients (P < 0.0001), in whom it was <2 in 13%. Even with the use of BP leads equipped with a 10 mm tip-to-ring spacing FFRS incidence was lower at the BB site (P < 0.01), FFRS trsh was lower (P < 0.001), and sensing safety margin was higher vs. RAA (P = 0.002). CONCLUSION: Bachmann's bundle area features optimal conditions for signal sensing, and such atrial lead positioning may offer advantages to prevent oversensing of R-wave, thus improving functioning of standard dual chamber pacemakers, ICDs and CRT-Ds.
Authors:
Ewa Lewicka-Nowak; Andrzej Kutarski; Alicja Dabrowska-Kugacka; Piotr Rucinski; Pawel Zagozdzon; Grzegorz Raczak
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-01-11
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  10     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-07     Completed Date:  2008-04-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  138-46     Citation Subset:  IM    
Affiliation:
Department of Cardiology and Electrotherapy, Medical University of Gdańsk, ul. Debinki 7, 80-211 Gdańsk, Poland. elew@amg.gda.pl
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Arrhythmia, Sinus / diagnosis*,  therapy*
Cardiac Pacing, Artificial / methods*
Electrodes, Implanted*
False Positive Reactions
Female
Follow-Up Studies
Heart Atria*
Humans
Male
Middle Aged
Pacemaker, Artificial*
Sensitivity and Specificity

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