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Long‐term Comparison of Unipolar and Bipolar Pacing and Sensing, Using a New Multiprogrammable Pacemaker System
Author(s) -
BREIVIK KJELL,
OHM OLEJÖRGEN,
ENGEDAL HOGNE
Publication year - 1983
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1983.tb05300.x
Subject(s) - medicine , term (time) , cardiac pacing , artificial cardiac pacemaker , cardiology , quantum mechanics , physics
Over a six‐month period a comparison was made between uni‐ and bipolar myocardial stimulation thresholds and R‐wave sensitivity in 15 consecutive pacemaker patients. The patients received a new multiprogrammable Cordis 336 A pulse generator, that could be programmed with either uni‐ or bipolar circuitry. In addition, rale, output, sensitivity and pacing mode could be noninvasively programmed. The occurrence of myopotential interference at different sensitivity levels was also studied. Cordis 325–161 bipolar endocardial leads were used in all patients. In one patient, the current output sometimes had to be programmed higher bipolarly than unipolarly to capture the ventricles, otherwise no differences in threshold were found. Acutely, R‐wave sensitivity was superior in 9 patients (60%) in the bipolar mode. Unipolar and bipolar electrograms were equal in 4 (26.7%), whereas unipolar R‐wave sensitivity was best in only 2 (13.3%) of the patients. At a six‐month follow‐up, the same tendency was found. In 5 patients, bipolar sensing was superior to unipolar, while uni‐and bipolar sensitivily was equal in the remaining patients. Myopotential inhibition was never seen in the bipolar mode at highest sensitivity (0.8 mV) even during provocative tests (n = 35) or 24‐hour Holter monitoring (n = 12). In the unipolar mode, 14/15 patients (93.3%) showed inhibition during provocative tests and 12/32 patients (100%) during monitoring at a programmed sensitivity of 0.8 mV. No patients had myopotential inlerference at a sensitivity level of 3.5 mV. All patients have theirpacemakers programmed in the bipolar mode after six months. This study con firms earlier acute data that the bipolar pacing mode is superior to the unipolar mode for permanent pacemaker therapy.