Schuchert A, Cappato R, Kuck K H, Meinertz T
Department of Cardiology, University-Hospital Eppendorf, Germany.
Pacing Clin Electrophysiol. 1996 Dec;19(12 Pt 1):2099-102. doi: 10.1111/j.1540-8159.1996.tb03284.x.
Presently available bipolar pacemakers connected to bipolar leads allow the programming of polarity to either bipolar or unipolar configuration. The bipolar configuration improves sensing because of its lack of oversensing. In respect to the pacing impulse, it may be beneficial to program the bipolar to unipolar configuration, because the unipolar pacing configuration seems to lead to lower pacing thresholds. The aim of the study was to investigate the effects of the two configurations on pacing and sensing in 11 patients with a new ventricular steroid-eluting lead (Encor Dec 033-301, Telectronics Inc.) connected to the same types of VVI(R) pacemakers. Follow-up was 12 months after implantation. Pacing was assessed by pulse duration thresholds at 0.8- 1.6-, and 2.5-V pulse amplitude and by pacing impedance. Parameters for sensing included sensing thresholds, R wave amplitudes, and amplitude of intrinsic deflection. Pulse duration thresholds were similar for the two configurations. At implantation, pacing impedance was significantly higher with bipolar (672 +/- 60 omega) than with unipolar pacing configuration (626 +/- 82 omega, P < 0.005). The difference lasted until 1 month after implantation (bipolar: 670 +/- 49 omega; unipolar: 63053 omega, P < 0.01). No significant differences were detected after 3 (bipolar: 683 +/- 63 omega; unipolar: 662 +/- 70 omega) and 12 months (bipolar: 658 +/- 64 omega; unipolar: 660 +/- 63 omega) between the 2 configurations. Although intrinsic deflections of ventricular electrograms were different, mean R wave amplitudes were similar in unipolar and bipolar configuration. Pacing and sensing characteristics of unipolar and bipolar configuration were similar for the studied bipolar pacing lead. Pacing impedance was initially higher for bipolar than for unipolar configuration and equilibrated within 3 months after implantation.
目前可用的与双极导联相连的双极起搏器可将极性编程为双极或单极配置。双极配置因其不存在过感知而改善了感知功能。就起搏脉冲而言，将双极配置编程为单极配置可能是有益的，因为单极起搏配置似乎能导致更低的起搏阈值。本研究的目的是调查这两种配置对11例植入了新型心室类固醇洗脱导联（Encor Dec 033 - 301，泰利特电子公司）并连接相同类型VVI(R)起搏器患者的起搏和感知的影响。随访在植入后12个月进行。通过0.8 - 1.6 - 和2.5 - V脉冲幅度下的脉宽阈值以及起搏阻抗来评估起搏情况。感知参数包括感知阈值、R波幅度和固有偏转幅度。两种配置的脉宽阈值相似。植入时，双极起搏时的起搏阻抗（672±60Ω）显著高于单极起搏配置（626±82Ω，P < 0.005）。这种差异一直持续到植入后1个月（双极：670±49Ω；单极：630±53Ω，P < 0.01）。在3个月（双极：683±63Ω；单极：662±70Ω）和12个月（双极：658±64Ω；单极：660±63Ω）时，两种配置之间未检测到显著差异。尽管心室电图的固有偏转不同，但单极和双极配置中的平均R波幅度相似。对于所研究的双极起搏导联，单极和双极配置的起搏和感知特性相似。双极起搏的起搏阻抗最初高于单极配置，并在植入后3个月内达到平衡。
