Varriale P, Pilla A G, Tekriwal M
Division of Cardiology, Cabrini Medical Center, New York, New York 10003.
Pacing Clin Electrophysiol. 1990 Jun;13(6):757-66. doi: 10.1111/j.1540-8159.1990.tb02102.x.
A single pass ventricular lead with a dual chamber electrode system, designed for VDD pacing, was implanted in 17 patients (11 men, 6 women, aged 53 to 86 years, mean 74) for symptomatic bradycardia due to second-or third-degree AV block and normal sinus node function. Bipolar atrial electrodes, diagonally displaced along the lead axis and positioned within the right atrial cavity, are used to detect atrial activity that is then differentially processed within the pacemaker. P wave amplitude (amp) derived from a PSA-DAA device at implant was 1.38 +/- 0.28 mV. P wave signal amp derived from telemetered atrial electrograms was 1.29 +/- 0.22 mV at predischarge (n = 17), 1.31 +/- 0.24 mV at 3 months (n = 15), 1.30 +/- 0.24 mV at 6 months (n = 8), 1.51 +/- 0.34 mV at 9 months (n = 4), and 1.35 +/- 0.35 mV at 12 months (n = 2); and the far-field QRS signal measured at predischarge was of negligible voltage (0.17 +/- 0.07 mV). The susceptibility of the atrial sensor system to interference was noted with chest wall stimulation and only at higher sensitivities (0.1 to 0.3 mV) and not with isometric arm exercise. Intact VDD pacing function at rest and during exercise was established using Holter and periodic ECG monitoring. Postoperative complications included one lead displacement and one pocket hematoma. Three patients died postimplant of causes unrelated to pacemaker function. Advantages of the single-lead VDD pacing include: (1) elimination of second atrial sensing lead; (2) superior atrial sensing performance; (3) effective resistance to myopotential and far-field signal interference; and (4) stability of postimplant atrial signal amplitude.
为17例有症状的心动过缓患者（11例男性，6例女性，年龄53至86岁，平均74岁）植入了一种单通道心室导联及双腔电极系统，该系统设计用于VDD起搏，这些患者因二度或三度房室传导阻滞且窦房结功能正常而出现症状性心动过缓。双极心房电极沿导联轴线对角移位并置于右心房腔内，用于检测心房活动，然后在起搏器内进行差分处理。植入时由PSA-DAA装置得出的P波振幅（amp）为1.38±0.28mV。遥测心房电图得出的P波信号振幅在出院前为1.29±0.22mV（n = 17），3个月时为1.31±0.24mV（n = 15），6个月时为1.30±0.24mV（n = 8），9个月时为1.51±0.34mV（n = 4），12个月时为1.35±0.35mV（n = 2）；出院前测量的远场QRS信号电压可忽略不计（0.17±0.07mV）。仅在较高灵敏度（0.1至0.3mV）下且在胸壁刺激时才注意到心房传感器系统对干扰敏感，等长手臂运动时则不敏感。通过动态心电图和定期心电图监测确定了静息和运动时完整的VDD起搏功能。术后并发症包括1例导线移位和1例囊袋血肿。3例患者植入后因与起搏器功能无关的原因死亡。单导联VDD起搏的优点包括：（1）消除第二根心房感知导线；（2）优异的心房感知性能；（3）有效抵抗肌电位和远场信号干扰；（4）植入后心房信号振幅稳定。
