title: Far field R-wave sensing in Myotonic Dystrophy type 1: right atrial appendage versus Bachmann's bundle region lead placement.
abstract: Aim of the present study was to investigate far field R-wave sensing (FFRS) timing and characteristics in 34 Myotonic Dystrophy type 1 (DM1) patients undergoing dual chamber pacemaker implantation, comparing Bachmann's bundle (BB) stimulation (16 patients) site with the conventional right atrial appendage (RAA) pacing site (18 patients). All measurements were done during sinus rhythm and in supine position, with unipolar (UP) and bipolar (BP) sensing configuration. The presence, amplitude threshold (FFRS trsh) and FFRS timing were determined. There were no differences between both atrial sites in the Pmin and Pmean values of sensed P-wave amplitudes, as well as between UP and BP sensing configurations. The FFRS trsh was lower at the BB region in comparison to the RAA site. The mean BP FFRS trsh was significantly lower than UP configuration in both atrial locations. There were no significant differences in atrial pacing threshold, sensing threshold and atrial lead impedances at the implant time and at FFRS measurements. Bachmann's bundle area is an optimal atrial lead position for signal sensing as well as conventional RAA, but it offers the advantage of reducing the oversensing of R-wave on the atrial lead, thus improving functioning of standard dual chamber pacemakers in DM1 patients.
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nigro
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Andrea
authors.initials: A
authors.lastname: Antonio Papa
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Anna
authors.initials: A
authors.lastname: Rago
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Federica
authors.initials: F
authors.lastname: Di Meo
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Anna
authors.initials: A
authors.lastname: Cristiano
authors.affiliation: Department of Respiratory Medicine, AO Monaldi, University Federico II of Naples, Italy;
authors.forename: Antonio
authors.initials: A
authors.lastname: Molino
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy;
authors.forename: Maria
authors.initials: M
authors.lastname: Giovanna Russo
authors.affiliation: Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Politano
mesh_terms: D000328:Adult; D020517:Atrial Appendage / Q000601:surgery*; D054537:Atrioventricular Block / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009223:Myotonic Dystrophy / Q000150:complications / Q000503:physiopathology*; D010138:Pacemaker, Artificial; D012189:Retrospective Studies
keywords: Bachmann's bundle; atrial lead; far field; far field R-wave sensing; myotonic dystrophy type 1; oversensing