Usefulness of a VDD-defibrillation-lead for recording atrial electrograms during atrial flutter and atrial fibrillation

被引:0
|
作者
Niehaus, M
Thuermer, G
Thamasett, S
Pfeiffer, D
Hoeper, K
Korte, T
Goerler, H
Belke, R
Tebbenjohanns, J
机构
[1] Med Hsch Hannover, Abt Kardiol & Angiol, D-30625 Hannover, Germany
[2] Univ Ulm, Abt Kardiol, D-89069 Ulm, Germany
[3] Univ Leipzig, Abt Kardiol, D-7010 Leipzig, Germany
[4] Med Hsch Hannover, Abt Herz Thorax & Gefasschirurg, D-30625 Hannover, Germany
[5] Biotron Berlin, Berlin, Germany
关键词
atrial fibrillation; atrial flutter; VDD; single-lead electrode; implantable cardioverter-defibrillators;
D O I
10.1007/PL00002005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Monitoring of atrial signals improves the accuracy in identifying supraventricular tachyarrhythmias to prevent inappropriate therapies in patients with implantable cardioverter-defibrillators (ICD). Since complications due to the additional atrial lead were found in dual chamber ICD systems with 2 leads, we designed a single-pass VDD-lead for use with dual chamber ICDs. Patients and Methods: After promising animal experiments in a German multicenter study a prototype VDD lead (single-coil defibrillation electrode with 2 additional fractally coated rings for bipolar sensing in the atrium) was temporarily used in 20 patients. Atrial and ventricular signals were recorded during sinus rhythm, atrial flutter, atrial fibrillation and ventricular tachycardia or ventricular fibrillation. Terminations of Ventricular arrhythmias were performed by internal DC shock. Results: The implantation of the electrode was successful in 18 of ro patients. Mean atrial pacing threshold was 2.45 +/- 0.9 V /0.5 ms, mean atrial impedance was 215 +/- 31 Ohm. Atrial amplitudes were greater during sinus rhythm (2.7 +/- 1.6 mV)than during atrial flutter (1.36 +/- 0.28 mV, p < 0.05) or atrial fibrillation (0.92 +/- 0.29 mV, p < 0.01). During ventricular fibrillation atrial "sinus"-signals had significantly (p < 0.01) lower amplitudes than during sinus rhythm. Mean ventricular sensing was 13.3 +/- 7.9 mV, mean ventricular impedance was 577 +/- 64 Ohm. Defibrillation was successful with 20 J shock. 99.6% of P waves could be detected in sinus rhythm and 85 +/- 9.9% of flutter waves du ring atrial flutter. During atrial fibrillation 55% of atrial signals could be detected without modification of the signal amplifier. Conclusions: A new designed VDD dual chamber electrode provides stable detection of atrial and ventricular signals during sinus rhythm and atrial flutter. For reliable detection of atrial fibrillation modifications of the signal amplifier are necessary.
引用
收藏
页码:40 / 48
页数:9
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