Improved technique in permanent atrial pacing.
At the present time, the relatively high atrial stimulation threshold and the low and often unstable P wave amplitude are the main concerns in atrial pacing. As a further contribution to the solution of this problem we used a screw-in atrial lead in 16 patients. During the implantation, atrial mapping was performed in order to establish the position with the best electrical performance. The acute threshold for voltage at a pulse duration of 1 ms averaged 0.49 +/- 0.18 Volt. The acute peak-to-peak P wave amplitude averaged 4.6 mV +/- 1.3. No complication occurred at the time of the implantation. Follow-up periods averaged 12 months. No dislocation or bleeding was observed during a follow-up period of up to 28 months. Using this lead together with intraoperative atrial mapping, it is possible to achieve an acute strength-duration relationship in the atrium at a level similar to that in the ventricle. The results of this study demonstrate that intraoperative mapping is an important stein in enhancing the safety margins and long-term performance of atrial pacing.
D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors