title: DDD and single-lead VDD pacing: evaluation of atrial signal dynamic changes.
abstract: BACKGROUND
  Single-lead VDD pacing systems are an alternative to conventional DDD pacemakers in patients with atrioventricular (AV) block and normal sinus function.
  
  
  OBJECTIVE
  The aim of this study was to assess changes of P-wave amplitude occurring in dynamic conditions in two groups of patients with a single-lead VDD and with a DDD pacing system, respectively.
  
  
  METHODS
  Twenty-eight patients with second- or third-degree AV block and normal sinus function were enrolled prospectively into the study. Seventeen patients were implanted with a single-lead VDD pacing system and 11 with a DDD pacemaker. Patients were evaluated at 3 months (all patients) and at 6 months (26 patients) at supine and in dynamic conditions (postural changes, hyperventilation, and during exercise).
  
  
  RESULTS
  Mean P-wave values at supine were 1.92 +/- 1.10 mV at 3 months and 1.76 +/- 1.01 mV at 6 months for VDD systems, and 4.63 +/- 2.18 mV at 3 months and 4.58 +/- 2.80 mV at 6 months for DDD pacemakers. In dynamic conditions, P-wave amplitude changes compared with supine condition ranged between -74 and +226% in VDD, and between -53 and +138% in DDD; however P-wave amplitudes showed no significant changes compared with baseline. Moreover, changes in atrial signal amplitudes did not occur randomly, and in both systems P-wave amplitudes remained significantly correlated with supine values.
  
  
  CONCLUSIONS
  A wide range of P-wave amplitude variations occurs in different postural conditions or during exercise, both with single-lead VDD and DDD pacing systems. However, with appropriate programming of atrial sensitivity based on supine values, constant atrial tracking can be maintained.
authors.affiliation: Institute of Cardiology, University of Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Boriani
authors.forename: M
authors.initials: M
authors.lastname: Biffi
authors.forename: A
authors.initials: A
authors.lastname: Bandini
authors.forename: P V
authors.initials: PV
authors.lastname: Moracchini
authors.forename: A
authors.initials: A
authors.lastname: Capucci
authors.forename: R
authors.initials: R
authors.lastname: Sigliano
authors.forename: A
authors.initials: A
authors.lastname: Mininno
authors.forename: A
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D005080:Exercise Test; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D012119:Respiration