Document Detail

Detection of atrial activation by intraventricular electrogram morphology analysis: a study to determine the feasibility of P wave synchronous pacing from a standard ventricular lead.
MedLine Citation:
PMID:  7686659     Owner:  NLM     Status:  MEDLINE    
The detection of atrial activation from a standard ventricular pacing lead with standard ventricular electrodes would provide patients with VVI and VVIR pacing systems atrial rate response and atrial synchrony. In addition to potentially increasing cardiac output appropriately in these patients at rest and during moderate exercise, P wave sensing with such a device could help reduce pacemaker syndrome. In this study, unipolar signals from distal and proximal intraventricular electrodes were recorded from the right ventricular apex in 20 patients. Unipolar electrograms from 16 patients were recorded using temporary electrophysiology catheters and in four patients using permanent pacemaker leads. Approximately 3 minutes of data per patient were acquired and analyzed. After selection of a P wave template, the difference in baseline normalized area between the template and signal was calculated on a point-by-point basis. The percent of atrial depolarizations correctly detected was determined for each patient and lead configuration at the optimal threshold. Far-field P wave accuracy was better at the proximal electrode (74 +/- 25%) than at the distal electrode (57 +/- 34%) (P < 0.025). At the proximal electrode, 15/20 (75%) patients had > 70% accuracy and 11/20 (55%) patients had > 80% accuracy. At the distal electrode, 10/21 (48%) patients had > 70% accuracy and 7/21 (33%) patients had > 80% accuracy. In conclusion, far-field detection of atrial activation at the ventricular proximal electrode appears possible with sufficient accuracy to provide periods of atrial rate response and synchrony in patients with a single standard lead.
S E Greenhut; J T Svinarich; N J Randall; S C Heald; T A Nappholz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  16     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1993 Jun 
Date Detail:
Created Date:  1993-08-05     Completed Date:  1993-08-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1293-303     Citation Subset:  IM    
Applied Research Division, Telectronics Pacing Systems, Englewood, Colorado 80112.
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MeSH Terms
Atrioventricular Node / physiology*
Cardiac Pacing, Artificial / methods*
Electrocardiography / methods
Electrodes, Implanted
Feasibility Studies
Heart Conduction System / physiology*
Middle Aged
Pacemaker, Artificial*
Sensitivity and Specificity
Signal Processing, Computer-Assisted*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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