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Atrial Lead Placement During Atrial Fibrillation. Is Restitution of Sinus Rhythm Required for Proper Lead Function? Feasibility and 12‐Month Functional Analysis
Author(s) -
WIEGAND UWE K.H.,
BODE FRANK,
BONNEMEIER HENDRIK,
TÖLG RALPH,
PETERS WERNER,
KATUS HUGO A.
Publication year - 2000
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.1540-8159.2000.tb00915.x
Subject(s) - medicine , atrial fibrillation , sinus rhythm , cardiology , cardioversion , atrium (architecture) , lead (geology) , intracardiac injection , anesthesia , geomorphology , geology
Unexpected atrial fibrillation (AF) during implantation of an atrial pacemaker lead is sometimes encountered. Infra‐operative cardioversion may lengthen and complicate the implantation process. This study prospectively investigates the performance of atrial leads implanted during AF (group A) and compares atrial sensing and pacing properties to an age‐ and sex‐matched control group in which sinus rhythm had been restored before atrial lead placement (group B). Patient groups consisted of 32 patients each. All patients received DDDE pacemakers and bipolar, steroid‐elating, active fixation atrial leads. In patients with AF at the time of implantation (group A), a minimal intracardiac fibrillatory amplitude of at least 1.0 mV was required for acceptable atrial lead placement. In patients with restored sinus rhythm (group B). a voltage threshold < 1.5 V at 0.5 ms and a minimal atrial potential amplitude > 1.5 mV was required. Patients of group A in whom spontaneous conversion to sinus rhythm did not occur within 4 weeks after implantation underwent electrical cardioversion to sinus rhythm. Pacemaker interrogations were performed 3, 6, and 12 months after implantation. In group A, implantation time was significantly shorter as compared to group B (58.7 ± 8.6 minutes vs 73.0 ± 17.3 minutes, P < 0.001). Mean atrial potential amplitude during AF was correlated with the telemetered atrial potential during sinus rhythm (r = 0.49, P < 0.001), but not with the atrial stimulation threshold. Twelve months after implantation, sensing thresholds (1.74 ± 0.52 mV vs 1.78 ± 0.69 mV, P = 0.98) and stimulation thresholds (1.09 ± 0.42 V vs 1.01 ± 0.31 V.P = 0.66) did not differ between groups A and B. However, in three, patients of group A, chronic atrial sensing threshold was ≤ 1 mV requiring atria) sensitivities of at least 0.35 mV to achieve reliable atrial sensing. Atrial lead placement during AF is feasible and reduces implantation time. However, bipolar atrial leads and the option to program high atrial sensitivities are required.