title: Early clinical experience with a minute ventilation sensor DDDR pacemaker.
abstract: The new DDDR pacemaker META DDDR utilizes a minute ventilation sensor based on transthoracic impedance measurements. The sensor determines the metabolic indicated interval, the atrioventricular (AV) delay and the postventricular atrial refractory period (PVARP). The baseline PVARP must be carefully selected to define nonphysiological tachycardias. If a P wave falls within the PVARP the pacemaker will automatically switch to the VVIR mode. This behavior prevents tracking of paroxysmal atrial tachyarrhythmias (PAT). Twenty-eight patients with sinus node dysfunction (n = 20), AV junction ablation (n = 5), complete or intermittent AV block (n = 3); who received a META DDDR pacemaker were studied. The mean age was 65 +/- 13 years.
  
  
  RESULTS
  mode switching (reversion) to VVIR was observed in 57% of the patients. Forty-two percent had episodes of mode switching to VVIR during a stress test, four related to PAT, and seven to sinus tachycardia. Fifty percent had episodes of mode switching to VVIR during a 24-hour Holter, four related to PAT, three to retrograde P wave sensing, and two to sinus tachycardia. At the last follow-up, 20 of the 26 patients initially programmed to the DDDR mode remained in the DDDR mode, while five were reprogrammed to the DDD and one to the VVIR mode. Mode switching has a high sensitivity but a low specificity for PAT. It appears to be a useful approach to prevent rapid tracking of atrial tachyarrhythmias. Careful PVARP programming is critical to appropriate reversion behavior, but further modifications of the algorithm are needed to improve its performance.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
authors.forename: G
authors.initials: G
authors.lastname: Vanerio
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: E
authors.initials: E
authors.lastname: Ching
authors.forename: R G
authors.initials: RG
authors.lastname: Trohman
authors.forename: B L
authors.initials: BL
authors.lastname: Wilkoff
authors.forename: L W
authors.initials: LW
authors.lastname: Castle
authors.forename: J D
authors.initials: JD
authors.lastname: Maloney
authors.forename: T W
authors.initials: TW
authors.lastname: Simmons
mesh_terms: D000368:Aged; D000465:Algorithms; D001146:Arrhythmia, Sinus / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012680:Sensitivity and Specificity; D012804:Sick Sinus Syndrome / Q000628:therapy; D013610:Tachycardia / Q000175:diagnosis