Brouwer J, Nagelkerke D, den Heijer P, Ruiter J H, Mulder H, Begemann M J, Lie K I
Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands.
Pacing Clin Electrophysiol. 1997 Apr;20(4 Pt 1):916-22. doi: 10.1111/j.1540-8159.1997.tb05494.x.
Accurate detection of the spontaneous far-field ventricular signal may be used to determine the ventricular activation, and hence, the interval from atrial stimulus to the ventricular R wave (AR interval) using a standard atrial pacing lead. This can be useful in developing a physiological atrial rate responsive (AAIR) pacemaker and in further improving DDD(R) pacing algorithms. In order to better characterize the atrial sensed far-field ventricular signal, 200 consecutive patients undergoing pacemaker implantation were studied. The amplitude of the far-field ventricular signal was significantly smaller than that of the atrial deflection. In all recordings, the slew rate of the atrial deflection was larger than that of the far-field ventricular signal. Subdivision of the recordings by electrode position, pocket location, or QRS duration on the surface ECG resulted in significantly different signal characteristics. The amplitude and slew rate of the far-field ventricular signal were significantly smaller in bipolar versus unipolar sensing. Atrial sensed far-field ventricular recordings could also be obtained in the case of ventricular pacing. Our results indicate that accurate sensing of the far-field ventricular signal from an atrial pacing lead is conceivable in most patients. The different signal characteristics in relation to parameters, such as electrode position, sensing mode, and pocket location, may be useful in determining the optimal conditions for signal sensing.
准确检测自发性远场心室信号可用于确定心室激动，从而使用标准心房起搏导线确定从心房刺激到心室R波的间期（AR间期）。这在开发生理性心房频率应答（AAIR）起搏器以及进一步改进DDD（R）起搏算法方面可能有用。为了更好地表征心房感知到的远场心室信号，对200例连续接受起搏器植入的患者进行了研究。远场心室信号的幅度明显小于心房波的幅度。在所有记录中，心房波的上升速率大于远场心室信号的上升速率。根据电极位置、囊袋位置或体表心电图上的QRS时限对记录进行细分，会导致显著不同的信号特征。双极感知时远场心室信号的幅度和上升速率明显小于单极感知。在心室起搏情况下也可获得心房感知到的远场心室记录。我们的结果表明，在大多数患者中，通过心房起搏导线准确感知远场心室信号是可行的。与电极位置、感知模式和囊袋位置等参数相关的不同信号特征，可能有助于确定信号感知的最佳条件。
