Sutton R, Fröhlig G, de Voogt W G, Goethals M, Hintringer F, Kennergren C, Scanu P, Guilleman D, Treese N, Hartung W M, Stammwitz E, Muetstege A
Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Europace. 2004 Nov;6(6):570-9. doi: 10.1016/j.eupc.2004.08.004.
This study investigated the ability to minimize pace polarization artefacts (PPA) by adjusting the post-stimulus pulse duration of a tri-phasic stimulation pulse. Adjustment of the stimulation pulse was enabled by downloading special study software into an already implanted pacemaker. Tests were performed in a total of 296 atrial leads and 311 ventricular leads. Both chronic and acute leads were included in the study. Statistically significant differences were found in the initial PPA (without any adjustment of the stimulus pulse) between atrial and ventricular leads. In addition, significant differences were observed among various lead models with respect to changes over time in the initial ventricular PPA. Successful PPA reduction was defined as a reduction of the PPA below 0.5 mV for atrial leads and below 1 mV for ventricular leads. Results show a success rate for ventricular and atrial PPA reduction of 97.8% and 98.7%, respectively. Threshold tests showed that after reduction of the PPA loss of ventricular capture can be reliably detected. However, atrial threshold tests showed many false positive evoked response detections. In addition, unexpectedly high evoked response amplitudes were observed in the atrium after reduction of the PPA. Results from additional measurements suggest that these high atrial evoked response amplitudes come from the influence of the input filter of the pacemaker.
本研究通过调整三相刺激脉冲的刺激后脉冲持续时间，调查了将起搏极化伪影（PPA）降至最低的能力。通过将特殊研究软件下载到已植入的起搏器中，实现对刺激脉冲的调整。总共对296根心房导联和311根心室导联进行了测试。研究中包括慢性和急性导联。心房和心室导联在初始PPA（未对刺激脉冲进行任何调整）方面存在统计学上的显著差异。此外，在不同导联型号之间，初始心室PPA随时间的变化也观察到显著差异。成功降低PPA的定义为心房导联的PPA降低至0.5 mV以下，心室导联的PPA降低至1 mV以下。结果显示，心室和心房PPA降低的成功率分别为97.8%和98.7%。阈值测试表明，PPA降低后，可以可靠地检测到心室夺获的丧失。然而，心房阈值测试显示出许多假阳性的诱发反应检测结果。此外，PPA降低后，心房中观察到意外高的诱发反应幅度。额外测量的结果表明，这些高心房诱发反应幅度来自起搏器输入滤波器的影响。
