Impaired activity rate responsiveness of an atrial activity-triggered pacemaker: the role of differential atrial sensing in its prevention.

Pacing and Clinical Electrophysiology : PACE
A H ShandlingM H Ellestad

Abstract

The physiological benefit of rate responsive, single-chamber cardiac pacing is well documented. We studied the activity response of nine atrially placed Activitrax II pacemakers. Seven patients were noted to have an inadequate activity-rate response with maximal pacing rates of 85 to 101 beats/min. Marker Channel analysis revealed that the upper rate timeout was reset by far-field R wave sensing, even when sensing occurred in the atrial refractory period. These 9 pacemakers were tested by atrial sensitivity adjustment for ability to exclude far-field R wave sensing, while preserving P wave sensing. Unipolar implantation data were then examined for predictors of this differential far-R and P-wave sensing. Differential atrial sensing occurred in 4/9 pacemakers (2/2 bipolar in the right atrial appendage; 0/1 bipolar in the coronary sinus; and 4/9 unipolar). An empirically developed index utilizing unipolar implant parameters discriminated outcomes for 8/9 unipolar pacemakers. We conclude that: (1) the rate responsiveness of the atrial Activitrax II pacemaker is limited by far-field R wave sensing even when this occurs during atrial channel refractoriness; (2) reprogramming atrial sensitivity to differentially sensed P and far-fiel...Continue Reading

References

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Citations

Jan 1, 2000·Herzschrittmachertherapie & Elektrophysiologie·M MeineJ Werner
Aug 1, 1991·Pacing and Clinical Electrophysiology : PACE·J BrandtH Schüller
Nov 1, 1992·Pacing and Clinical Electrophysiology : PACE·J N GrossS Furman
Aug 1, 1992·Pacing and Clinical Electrophysiology : PACE·C P Lau

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