Neuzner J, Sperzel J, Pitschner H F, Schwarz T, Ehrlich W, Schulte B, Haberbosch W
Department of Cardiology, Kerckhoff Clinic, Beneke Strasse 2-8, 61231 Bad Nauheim, Germany.
Europace. 1999 Apr;1(2):135-9. doi: 10.1053/eupc.1998.0028.
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, Ela Medical n = 13; Meta DDDR 1254, Telectronics Pacing Systems n = 12; Vigor DR 1230, Guidant n = 6; Trilogy DR 2364, Pacesetter, n = 2; Kappa DR 401, Medtronic USA n = 10). Every patient received a steroid-eluting, screwing, bipolar atrial lead (Medtronic, Capsure-Fix 4068). 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 tachyarrhythmias 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%.
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.
双腔起搏器中的自动模式切换（AMS）功能取决于对房性快速心律失常的充分检测。关于窦性心律期间术中心房信号幅度如何预测起搏器植入后房性快速心律失常的数据很少。在43例因药物难治性阵发性心房颤动接受DDDR起搏器植入和房室结消融的患者中，分析了窦性心律期间和诱发房性快速心律失常期间（设备植入后24 - 48小时）的心房感知阈值。植入了五种不同的DDDR起搏器系统（Chorus 7034，伊拉医疗公司，n = 13；Meta DDDR 1254，泰利特电子起搏系统公司，n = 12；Vigor DR 1230，Guidant公司，n = 6；Trilogy DR 2364，百盛公司，n = 2；Kappa DR 401，美敦力美国公司，n = 10）。每位患者均接受了类固醇洗脱、旋拧式双极心房电极（美敦力，Capsure - Fix 4068）。植入期间平均P波幅度为3.91±1.14 mV。窦性心律期间和所有诱发房性快速心律失常模式下的平均心房感知阈值分别为3.35±1.0 mV和1.52±0.92 mV（P < 0.001）。36例患者诱发了心房颤动。该患者组窦性心律期间的平均感知阈值为3.39±1.01 mV，心房颤动期间的平均感知阈值为1.27±0.56 mV，与窦性心律相比，感知阈值降低了63%（P < 0.001）。7例患者诱发了心房扑动。窦性心律期间的平均感知阈值为2.92±1.19 mV，心房扑动期间的平均感知阈值为2.79±1.26 mV，与窦性心律相比降低了5%（无统计学意义）。窦性心律期间的心房感知阈值与房性快速心律失常期间的感知阈值显著相关（r = 0.44；P < 0.002），但个体结果存在显著差异。窦性心律和诱发房性快速心律失常之间心房感知阈值的降低范围为30%至82%。
窦性心律期间的双极心房感知阈值与房性快速心律失常期间的感知阈值相关，但个体患者存在很大差异。基于窦性心律期间感知阈值的4:1至5:1心房感知安全裕度是术后充分检测房性快速心律失常和AMS设备功能的预测指标。
