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Usefulness of Echocardiography to Predict Inappropriate Atrial Sensing in Single‐Lead VDD Pacing
Author(s) -
COCK CAREL C.,
CAMPEN LINDA C.M.C.,
HUYGENS JEROEN,
KAMP OTTO,
VISSER CEES A.
Publication year - 1999
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.1540-8159.1999.tb00627.x
Subject(s) - medicine , cardiology , coronary sinus , atrium (architecture) , ventricle , diastole , atrial fibrillation , blood pressure
Reliable atrial sensing is the prerequisite for restoration of atrioventricular synchrony in patients with single‐lead VDD pacing systems. To determine echocardiographic variables associated with inappropriate atrial sensing, 21 consecutive patients with symptomatic second‐ or third‐degree AV block and normal sinus node function were studied. Prior to implantation echocardiographic measurements of end‐systolic and end‐diastolic dimensions and volumes of the right atrium and right ventricle were performed. All patients underwent implantation of a Medtronic Thera VDD(d) pacemaker with a bipolar Medtronic Capsure electrode. A minimal amplitude of the unfiltered atrial electrocardiogram of ≥ 0.5 mV was required for permanent lead position and the atrial sensitivity was programmed below the lowest recorded value. Appropriate atrial sensing (atrial triggered ventricular paced complexes/total number of ventricular paced complexes) was assessed during 24‐hour Holter monitoring and treadmill exercise testing 3 to 6 weeks after implantation. Inappropriate atrial sensing (< 95% correct atrial synchronization during Holter registration and/or < 97.5% during exercise testing) was present in nine patients. Right atrial volumes and the right ventricular end‐diastolic volume was significantly higher, as compared to patients without inappropriate sensing (12 patients). The right atrial and diastolic volumes had the highest correlation with correct atrial sensing r = 0.83, P < 0.0001). Using a postdefined cut‐off value of ≥ 80 mL for the end‐diastolic right atrial volume, sensitivity and specificity for inappropriate sensing was 100% and 92%, respectively. These findings show that preimplant echocardiography can identify patients with inappropriate sensing during VDD pacing, in whom DDD pacing should be considered.