The Effect of Bipole Tip-to-Ring Distance in Atrial Electrodes upon Atrial Tachyarrhythmia Sensing Capability in Modern Dual-Chamber Pacemakers

Silberbauer, John; Arya, Anita; Veasey, Rick A.; Boodhoo, Lana; Kamalvand, Kayvan; O’Nunain, Sean; Hildick‐Smith, David; Paul, Vince; Patel, Nikhil; Lloyd, Guy; Sulke, Neil

doi:10.1111/j.1540-8159.2009.02576.x

Cited by 11 publications

(7 citation statements)

References 35 publications

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“…23, 24 The capture and sensing thresholds of these leads were similar and remained stable in the long term. [23][24][25] In our study, the prevalence of sensed FFRW in the LAS region at an atrial sensitivity ≥0.3 mV was significantly higher when the ring-tip electrodes spacing was 10.0 mm than when it was 1.1 mm, while the pacing and sensing thresholds were similar. Thus, a shorter interelectrode spacing of the atrial lead lowered the likelihood of sensed FFRW, without interfering with pacing.…”

Section: Discussionmentioning

confidence: 69%

“…18 Effects of the Spacing of the Tip-Ring Electrode of the Bipolar Atrial Lead on FFRW Sensing in the LAS The interelectrode spacing of bipolar atrial leads determines, in part, the likelihood of FFRW sensing, 8,23-25 which tends to decrease as the spacing narrows. [23][24][25] In the RAA, at a sensitivity of 0.3 mV, FFRW were sensed in 30% of recipients of leads with 10-mm interelectrode spacing, and in none of the patients who received leads with ring-tip electrodes separated by 1.1 mm. 23, 24 The capture and sensing thresholds of these leads were similar and remained stable in the long term.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Characteristics of Far-Field R-Wave Sensing in Low Right Atrial Septum Pacing

Minamiguchi

Abe

Kohno

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp acemaker diagnostics have become an important means of detecting and monitoring atrial tachyarrhythmias (ATA) in recipients of pacemakers implanted for bradyarrhythmias. State-of-the-art dual-chamber devices provide useful diagnostic information, including the number and duration of automatic mode switch episodes upon detection of ATA. In the recent ASSERT trial, with over 2.8 years of follow-up, (1) ATA were detected by the atrial high rate episode function in 36% of 2,580 pacemaker or implantable defibrillator recipients who had no history of ATA before device implantation, and (2) a 2.5-fold higher incidence of ischemic stroke or systemic embolism was observed in patients with than in patients without ATA detected by the atrial high rate function. 1,2 Therefore, accurate identification of ATA allows the planning of optimal antiarrhythmic and antithrombotic therapy. 3 However, the sensing of the far-field R-wave (FFRW) by the atrial channel may cause inappropriate mode switches from DDD to DDI mode, and trigger ATA or cause pacemaker syndrome. 4-14 Editorial p 582The right atrial appendage (RAA) is believed to be an unsuitable pacing site for the prevention of ATA, because it lengthens the inter-or intraatrial conduction time and increases the dispersion of atrial refractoriness. 15 Therefore, low atrial septal (LAS) pacing has been recommended instead of RAA pacing to prevent ATA, 16 though this remains to be confirmed by randomized clinical trial. 17 However, because the LAS region is closer to the ventricle than the RAA, it may be associated with a higher likelihood of FFRW oversensing, 16,18 though the prevalence and characteristics of FFRW sensing associated with LAS pacing have not been formally studied.We hypothesized that recipients of bipolar atrial leads with widely spaced tip-ring electrodes implanted in the LAS and who have left ventricular hypertrophy (LVH) on 12-lead ECG are at increased risk of FFRW sensing after ventricular pacing. To test this hypothesis, we measured the prevalence and examined the characteristics of FFRW sensing in recipients of dualchamber pacemakers, as well as the effects of the tip-ring Toshihisa Nagatomo, MD; Yutaka Otsuji, MD Background: Although low atrial septal (LAS) pacing may prevent atrial tachyarrhythmias in selected patients, farfield R-wave (FFRW) sensing in this region seems more likely than in the right atrial appendage.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Incidence and Characteristics of Far-Field R-Wave Sensing in Low Right Atrial Septum Pacing

Minamiguchi

Abe

Kohno

et al. 2012

Circ J

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“…The reliability of AHRE detection depends on adequate sensing and discrimination of atrial potentials. [1][2][3] Intermittent undersensing of continuous AF and undersensing of very short episodes of AF or other ATAs are often observed and may cause inappropriate AHRE detection. [1,3,4] And conversely, oversensing of far-field R-wave (FFRW) [5] or sensing of retrograde atrial depolarizations [4,6,7] may erroneously trigger AHRE detection.…”

Section: Introductionmentioning

confidence: 99%

Enhanced detection of atrial tachyarrhythmias with pacing devices by using more accurate atrial sensing

Pakarinen

Lehto

Ruiter

et al. 2021

J Interv Card Electrophysiol

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Purpose Cardiac pacing devices can detect and monitor atrial tachyarrhythmias (ATA) which increase the risk of thromboembolic complications. The aim of this study was to compare (1) two different atrial leads and (2) standard and optimized settings to detect ATA and reject far-field R-wave signal (FFRW). Methods This was a prospective, randomized multi-center trial comparing St. Jude Medical OptiSense lead (tip-to-ring spacing 1.1 mm) and Tendril lead (tip-to-ring spacing 10.0 mm), having programmed atrial sensitivity at 0.2 mV and post-ventricular atrial blanking at 60 ms. We measured intra-atrial amplitudes of FFRW, intrinsic atrial signals, the amount of FFRW oversensing, and other inappropriate mode switching. Results One hundred and ten patients were enrolled. The mean amplitude of sensed and paced FFRW bipolar signal was 0.13 mV vs. 0.21 mV (p < 0.001) and 0.13 mV vs. 0.26 mV (p < 0.001) with OptiSense and Tendril lead, respectively. The mean amplitude of the atrial bipolar signal was 2.84 mV with OptiSense and 3.48 mV with Tendril lead, p = 0.014. With the optimized settings with OptiSense lead, one patient out of 20 (5%) had FFRW oversensing, none had undersensing of ATAs due to 2:1-blanking of atrial depolarizations, and the concordance of the ATAs by Holter and pacemaker memory was high (Spearman’s rank correlation coefficient = 0.90). In the Tendril group, 12 out of 25 patients (48%) had oversensing and 4 had atrial undersensing (p < 0.001). Conclusions The technique with an atrial lead with short tip-to-ring spacing combined with optimized pacemaker programming resulted in reliable and accurate atrial arrhythmia detection. Trial registration ClinicalTrials.gov number NCT01074749.

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“…Recent studies have shown that reducing the inter-electrode tip-to-ring spacing of atrial bipolar leads reduces the amplitude of far-field R-wave and consequently the occurrence of inappropriate mode switches [16], [17]. With the availability of new leads providing a very short tip-to-ring distance of 1.1 mm instead of traditional 10 mm spacing, FFS may be further reduced [18]–[20] and individual adjustment of pacemaker settings may no longer necessary to avoid FFS.…”

Section: Introductionmentioning

confidence: 99%

Use of an Atrial Lead with Very Short Tip-To-Ring Spacing Avoids Oversensing of Far-Field R-Wave

Kolb

Nölker²,

Lennerz³

et al. 2012

PLoS ONE

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ObjectiveThe 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.MethodsPatients 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.ResultsA 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).ConclusionThe 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 RegistrationClinicalTrials.gov NCT00512915

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The Effect of Bipole Tip-to-Ring Distance in Atrial Electrodes upon Atrial Tachyarrhythmia Sensing Capability in Modern Dual-Chamber Pacemakers

Cited by 11 publications

References 35 publications

Incidence and Characteristics of Far-Field R-Wave Sensing in Low Right Atrial Septum Pacing

Incidence and Characteristics of Far-Field R-Wave Sensing in Low Right Atrial Septum Pacing

Enhanced detection of atrial tachyarrhythmias with pacing devices by using more accurate atrial sensing

Use of an Atrial Lead with Very Short Tip-To-Ring Spacing Avoids Oversensing of Far-Field R-Wave

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