Nielsen A P, Cashion W R, Spencer W H, Norton H J, Divine G W, Schuenemeyer T D, Griffin J C
J Am Coll Cardiol. 1985 May;5(5):1198-204. doi: 10.1016/s0735-1097(85)80025-5.
Acute and long-term pacing thresholds were measured prospectively in 74 patients with a unipolar/bipolar multiprogrammable pacemaker. At implantation, mean current threshold was 0.48 +/- 0.16 mA with unipolar mode and 0.55 +/- 0.16 mA bipolar mode (p less than 0.01). R wave amplitude at implantation was 7.78 +/- 2.4 mV with unipolar and 7.67 +/- 2.1 mV in bipolar mode (p = NS). During long-term follow-up (mean 9.3 months; range 3 to 24), no clinically significant differences in pacing or sensing thresholds were observed between bipolar and unipolar configurations. Lead configuration was changed 23 times in 11 patients. Symptomatic myopotential inhibition was corrected in two patients by reprogramming to the bipolar pacing mode. High thresholds and loss of capture were corrected in two patients by reprogramming to the unipolar pacing mode. The remaining configurational changes were made for improved sensing or pacing thresholds. This study documents, in a large group of patients, the equivalence of long-term unipolar and bipolar pacing and sensing thresholds and, in addition, demonstrates that lead configuration programmability offered some advantage in a subgroup of patients and may have prevented reoperation in five patients.
对74例使用单极/双极多程控起搏器的患者进行了急性和长期起搏阈值的前瞻性测量。植入时，单极模式下平均电流阈值为0.48±0.16 mA，双极模式下为0.55±0.16 mA（p<0.01）。植入时单极R波振幅为7.78±2.4 mV，双极模式下为7.67±2.1 mV（p=无显著性差异）。在长期随访期间（平均9.3个月；范围3至24个月），双极和单极配置之间在起搏或感知阈值方面未观察到临床显著差异。11例患者的导线配置改变了23次。两名患者通过重新程控为双极起搏模式纠正了有症状的肌电位抑制。两名患者通过重新程控为单极起搏模式纠正了高阈值和夺获丧失。其余的配置改变是为了改善感知或起搏阈值。这项研究在一大组患者中证明了长期单极和双极起搏及感知阈值的等效性，此外，还表明导线配置的可编程性在一部分患者中具有一些优势，并且可能避免了5例患者的再次手术。
