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Variation in P Wave Amplitude Immediately After Pacemaker Implantation: Possible Mechanism and Implications for Early Programming
Author(s) -
SHANDLING ADRIAN H.,
CASTELLANET MARK J.,
THOMAS LAVERGNE A.,
MULVIHILL DANIEL F.,
FEUER JOSHUA M.,
MESSENGER JOHN G.
Publication year - 1989
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.1540-8159.1989.tb01866.x
Subject(s) - medicine , mechanism (biology) , variation (astronomy) , amplitude , cardiology , philosophy , physics , epistemology , quantum mechanics , astrophysics
SHANDLING, A.H., et al .: Variation in P Wave Amplitude Immediately After Pacemaker Implantation: Possible Mechanism and Implications for Early Programming The P ivave amplitude (PWA) plays an important role in doterirnning atrial sensing capabilities. To assess early PWA change, we compared lhe unipolar PWA in 43 patients at the time of atrial lead placement, measured by a pacing systems analyzer, to the unipolar PWA recorded at the end of pacemaker surgery, from telemetered airial endocardial electrograms. Individual PWA varied from a decrease of 5.2 mV lo an increase of 2 mV (−63% to 267%). In 33 patients with active fixation leads, the implant PWA was 1.96 ± 0.99mV versus 2.4 ± 1.4 mV after surgery. In 11 patients with passive fixation leads, the implant PWA was 2.8 ± 1.9 mV versus 1.9 ± 0.8 mV after surgery. The PWA change, measured as the difference between the postsurgical and implant PWA was 0.43 ± 0.8mV in active versus −0.86 ± 1.6 mV in the passive fixation lead groups (P < 0.05). Considerable change in individual P wave ampiitude can therefore occur very early after pacemaker implantation. The direction differs significantly between active (predominantly positive) and passive fixation groups (predominantly negative). These data suggest that an adequate margin of safety is important when initially programming atrial sensitivity, particularly when using passive fixation leads.