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Underrecognized entity of the transient rise in the atrial capture threshold early after dual‐chamber pacemaker implantation
Author(s) -
Uehara Yoshiko,
Yoshida Kentaro,
Kimata Akira,
Ogawa Kojiro,
Abe Daisuke,
Tsumagari Yasuaki,
Tsuneoka Hidekazu,
Yui Yoshiaki,
Ito Yoko,
Ebine Mari,
Takeyasu Noriyuki,
Aonuma Kazutaka,
Nogami Akihiko
Publication year - 2017
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/pace.13235
Subject(s) - medicine , sick sinus syndrome , atrial fibrillation , odds ratio , confidence interval , cardiology , sss* , atrioventricular block , logistic regression
Background Steroid‐eluting pacemaker leads suppress acute rises in pacing threshold by preventing inflammatory processes. However, we occasionally encounter not persistent but transient rise in the atrial capture threshold (TRACT) early after pacemaker implantation. We believe that this phenomenon is underrecognized in clinical practice and may potentially lead to unnecessary reintervention. We aimed to clarify the prevalence, predictors, and possible mechanisms of TRACT. Methods and results We reviewed clinical records from 239 consecutive patients who underwent dual‐chamber pacemaker implantation for sick sinus syndrome (SSS) (N = 102) or atrioventricular block (AVB) (N = 137). Atrial capture threshold was measured at implantation and 7 days, 2 months, and 8 months postimplantation. TRACT was defined as a rise in the threshold at day 7 to ≥twice that at implantation, with an absolute value ≥1.0 V/0.4 ms, and full recovery by 8 months into follow‐up. TRACT was observed in 15 patients (6%), of whom13 (87%) suffered from SSS but not AVB. Patients with TRACT had greater body mass index (BMI) (25 ± 5 kg/m 2 vs 23 ± 4 kg/m 2 , P = 0.01), larger left atrium (42 ± 5 mm vs 38 ± 7 mm, P = 0.03), and were more likely to suffer from paroxysmal atrial fibrillation (60% vs 31%, P = 0.02) than those without TRACT. In multivariable logistic regression analysis, BMI and SSS were the independent predictors of TRACT (odds ratio [OR], 1.172; 95% confidence interval [CI], 1.019–1.349; P = 0.03 and OR, 11.53; 95% CI, 2.010–66.21; P = 0.006, respectively). Conclusions The distinct phenomenon of TRACT was not rare in clinical practice early after dual‐chamber pacemaker implantation, and its occurrence was strongly associated with SSS.