Use of an atrial lead with very short tip-to-ring spacing avoids oversensing of far-field R-wave

Christof Kolb, Georg Nölker, Carsten Lennerz, Hansmartin Jetter, Verena Semmler, Klaus Pürner, Klaus-Jürgen Gutleben, Tilko Reents, Klaus Lang, Ulrich Lotze, AVOID-FFS Investigators, C Kolb, C Lennerz, V Semmler, T Reents, B Zrenner, R Schmidt, A Stein, M Felizeter, G Nölker, K-J Gutleben, G Ritscher, J Brachmann, U Lotze, W Fettin, H Jetter, K Pürner, H-L Schneider, K Lang, L-G Binner, V Schibgilla, S Weyerbrock, R Ventura, Christof Kolb, Georg Nölker, Carsten Lennerz, Hansmartin Jetter, Verena Semmler, Klaus Pürner, Klaus-Jürgen Gutleben, Tilko Reents, Klaus Lang, Ulrich Lotze, AVOID-FFS Investigators, C Kolb, C Lennerz, V Semmler, T Reents, B Zrenner, R Schmidt, A Stein, M Felizeter, G Nölker, K-J Gutleben, G Ritscher, J Brachmann, U Lotze, W Fettin, H Jetter, K Pürner, H-L Schneider, K Lang, L-G Binner, V Schibgilla, S Weyerbrock, R Ventura

Abstract

Objective: The AVOID-FFS (Avoidance of Far-Field R-wave Sensing) study aimed to investigate whether an atrial lead with a very short tip-to-ring spacing without optimization of pacemaker settings shows equally low incidence of far-field R-wave sensing (FFS) when compared to a conventional atrial lead in combination with optimization of the programming.

Methods: Patients receiving a dual chamber pacemaker were randomly assigned to receive an atrial lead with a tip-to-ring spacing of 1.1 mm or a lead with a conventional tip-to-ring spacing of 10 mm. Postventricular atrial blanking (PVAB) was programmed to the shortest possible value of 60 ms in the study group, and to an individually determined optimized value in the control group. Atrial sensing threshold was programmed to 0.3 mV in both groups. False positive mode switch caused by FFS was evaluated at one and three months post implantation.

Results: A total of 204 patients (121 male; age 73±10 years) were included in the study. False positive mode switch caused by FFS was detected in one (1%) patient of the study group and two (2%) patients of the control group (p = 0.62).

Conclusion: The use of an atrial electrode with a very short tip-to-ring spacing avoids inappropriate mode switch caused by FFS without the need for individual PVAB optimization.

Trial registration: ClinicalTrials.gov NCT00512915.

Conflict of interest statement

Competing Interests: This study was financially supported by St. Jude Medical, Eschborn, Germany. CK has received lecture fees from Biotronik, Boston, Medtronic, Sorin, and St. Jude Medical, and is or was an advisor to Biotronik, Sorin and St. Jude Medical. GN and KG received lecture fees from Biotronik, Medtronic, Sorin and St. Jude Medical. GN received support for travelling when presenting study data from St. Jude Medical. UL has received lecture fees from Medtronic and St. Jude Medical. All other authors have declared that no competing interests exist. This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1. Study flow-chart.
Figure 1. Study flow-chart.
Figure 2. Inappropriate mode switch due to…
Figure 2. Inappropriate mode switch due to FFS: Stored episode depicting inappropriate mode switch due to FFS from the control group.
Despite optimized PVAB of 140 ms inappropriate mode switch occurs because the coupling interval of the far-field R-wave is 160 ms. First line: bipolar atrial electrogram, shows bipolar atrial, second line: bipolar ventricular electrogram, bottom line: marker channel with AMS = mode switch; AP = atrial pacing; AS = atrial sensed event; AS on black background = atrial sensed event in refractory period; VP = ventricular pacing.
Figure 3. Distribution of programmed PVAB during…
Figure 3. Distribution of programmed PVAB during follow-up by randomization groups.
Nine patients of the study group initially received a PVAB that was erroneously programmed to a value other than 60 ms which was corrected after one month in eight of the patients and remained prolonged in one patient. None of these patients had inappropriate mode switch due to FFS. One patient of the study group patient exhibited inappropriate mode switch due to FFS and the PVAB was then individually optimized (150 ms). For the control group PVAB is shown as determined to be optimal at discharge. In case of changes of the PVAB programming during the follow-up, the longest programmed PVAB for both groups are displayed.

References

    1. Fitts SM, Hill MR, Mehra R, Gillis AM. High rate atrial tachyarrhythmia detections in implantable pulse generators: low incidence of false-positive detections. The PA Clinical Trial Investigators. Pacing Clin Electrophysiol. 2000;23:1080–6.
    1. Pürerfellner H, Gillis AM, Holbrook R, Hettrick DA. Accuracy of atrial tachyarrhythmia detection in implantable devices with arrhythmia therapies. Pacing Clin Electrophysiol. 2004;27:983–92.
    1. De Voogt WG, van Hemel NM, van de Bos AA, Koistinen J, Fast JH. Verification of pacemaker automatic mode switching for the detection of atrial fibrillation and atrial tachycardia with Holter recording. Europace. 2006;8:950–61.
    1. De Voogt WG, van Hemel NM. Clinical application of pacemakers in atrial tachyarrhythmias. Neth Heart J. 2008. pp. S20–4.
    1. Glotzer TV, Hellkamp AS, Zimmerman J, Sweeney MO, Yee R, et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke. Circulation. 2003;107:1614–9.
    1. Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, et al. Presence and duration of atrial fibrillation detected by continuous monitoring: crucial implications for the risk of thromboembolic events. J Cardiovasc Electrophysiol. 2009;20:241–8.
    1. Kolb C, Aratma S, Zrenner B, Schmitt C. Preventricular far-field sensing in the atrial channel of dual chamber pacemakers - an occasional cause of inappropriate mode switch. J Interv Card Electrophysiol. 2004;10:231–5.
    1. Kolb C, Wille B, Maurer D, Schuchert A, Weber R, et al. Management of far-field R wave sensing for the avoidance of inappropriate mode switch in dual chaber pacemakers: results of the FFS-test study. J Cardiovasc Electrophysiol. 2006;17:992–7.
    1. De Voogt WG, Van Mechelen R, van den Bos AA, Scheffer M, et al. Electrical characteristics of low atrial septum pacing compared with right atrial appendage pacing. Europace. 2005;7:60–6.
    1. De Voogt WG, van Hemel NM. Diagnostic tools for atrial tachyarrhythmias in implantable pacemakers: a review of technical options and pitfalls. Neth Heart J. 2008;16:201–10.
    1. Fröhlig G, Helwani Z, Kusch O, Berg M Schieffer H. Bipolar ventricular far-field signals in the atrium. Pacing Clin Electrophysiol. 1999;22:1604–13.
    1. Nowak B, Kracker S, Rippin G, Horstick G, Vincent A, et al. Effect of the atrial blanking time on the detection of atrial fibrillation in dual chamber pacing. Pacing Clin Electrophysiol. 2001;24:496–9.
    1. Leung SK, Lau CP, Lam CT, Tse HF, Tang MO, et al. Programmed atrial sensitivity: a critical determinant in atrial fibrillation detection and optimal automatic mode switching. Pacing Clin Electrophysiol. 1998;21:2214–9.
    1. Walfridsson H, Aunes M, Capocci M, Edvardsson N. Sensing of atrial fibrillation by a dual chamber pacemaker: how should atrial sensing be programmed to ensure adequate mode shifting? Pacing Clin Electrophysiol. 2000;23:1089–93.
    1. Goethals M, Timmermans W, Geelen P, Backers J, Brugada P. Mode switching failure during atrial flutter: the ‘2:1 lock-in’ phenomenon. Europace. 2003;5:95–102.
    1. Nash A, Fröhlig G, Taborsky M, Stammwitz E, Maru F, et al. Rejection for atrial sensing artifacts by a pacing lead with short tip-to-ring spacing. Europace. 2005;7:67–72.
    1. Silberbauer J, Arya A, Veasey RA, Boodhoo L, Kamalvand K, et al. The effect of bipole tip-to-ring distance in atrial electrodes upon atrial tachyarrhythmia sensing capabilities in modern dual-chamber pacemaker. Pacing Clin Electrophysiol. 2010;33:85–93.
    1. De GrootJR, Schroeder-Tanka JM, Visser J, Willems AR, de Voogt WG. Clinical results of far-field R-wave reduction with a short tip-ring electrode. Pacing Clin Electrophysiol. 2008;31:1554–9.
    1. De Voogt W, Van Hemel N, Visser J, Chitre Y, Bornzin G, et al. Far-field R-wave reduction with a novel lead design: experimental human results. Pacing Clin Electrophysiol. 2005;28:782–8.
    1. Fung JW, Sperzel J, Yu CM, Chan JY, Gelder RN, et al. Multicenter clinical experience with an atrial lead designed to minimize far-field R-wave sensing. Europace. 2009;11:618–24.
    1. Inama G, Santini M, Padeletti L, Boriani G, Bott G, et al. Far-field R wave oversensing in dual chamber pacemakers designed for atrial arrhythmia management: Effect of pacing site and lead tip to ring distance. Pacing Clin Electrophysiol. 2004;27:1221–30.
    1. Minamiguchi H, Abe H, Kohno R, Oginosawa Y Tamura M, et al. Incidence and characteristics of far-field R-wave sensing in low right atrial septum pacing. Circ J. 2012;76:598–606.
    1. Lewicka-Nowak E, Kutarski A, Dabrowska-Kugacka A, Rucinski P, Zagozdzon P, Raczak G. Atrial lead location at the Bachmanńs bundle region results in a low incidence of far field R-wave sensing. Europace. 2008;10:138–46.
    1. Jastrzebski M. Ventricular activation sequence during left ventricular pacing promotes QRS complex oversensing in the atrial channel. Pacing Clin Electrophysiol. 2011;34:1682–86.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever