Clinical Evaluation of VDD Pacing with a Unipolar Single‐Pass Lead

Abstract

Twenty patients with advanced AV block and normal sinus node function underwent pacemaker implantation, randomly receiving a CPI 910 ULTRA II model VDD pacemaker. The first 13 patients received the implantation of a single lead with a screw-in positive ventricular fixation tip and a unipolar ring floating atrial electrode spaced 13 cm from the tip. A subsequent group of seven patients received a conventional porous tinned-tip lead with a pair of unipolar ring floating electrodes. The second solution was adopted because the best atrial signal was not always in the high or mid-high atrium portion, but sometimes in the middle or mid-low position. With the modified double-electrode lead, the floating atrial electrode that detects the best signal can be selected, cutting out the pin of the one not used. The comparisons between minimal atrial slew rate and maximal ventricular slew rate, as well as those between minimal P wave amplitude and maximal R wave amplitude, show a highly significant range difference, as large as P less than 0.01. Surface electrocardiograms, stress tests, and 24-hour Holter monitoring showed the correct functioning of the system with an average sensing failure from 0.05 to 1%. In conclusion, VDD stimulation is feasible with a single unipolar lead and a floating atrial electrode in conjunction with a pacemaker generator (CPI 910 ULTRA II) originally designed for permanent twin-lead implantation.

VDD(R) Pacing: Short‐ and Long‐Term Stability of Atrial Sensing with a Single Lead System

“…min above programmed lower rate to 5 beats/ min below maximum pacing rate 5(1)(2)(3)(4)(5)(6)(7)(8)(9)(10) …”

VDD Lead Extraction—Differences with Other Leads and Practical Tips in Management

“…Permanent VDD (atrial potential-controlled ventricular inhibited) pacing using a single ventricular lead with two floating rings at the atrial level for the detection of atrial potentials was introduced more than 30 years ago [1][2][3][4][5]. This kind of pacing system is designed for patients with atrioventricular block and normal sinus node function [6].…”

“…This kind of pacing system is designed for patients with atrioventricular block and normal sinus node function [6]. It allows the maintenance of AV synchronous pacing and its hemodynamic advantages [3,4,7]. The disadvantages include a relatively frequent atrial undersensing in 4% to 16% [8][9][10][11] and a risk of sinus node dysfunction with a subsequent need for an upgrade to DDD pacing [8,12].…”

“…VDD leads have four conductors and three ring electrodes and, therefore, have a more delicate structure than standard PM leads [1][2][3][4][5]. Two atrial electrodes with rings, often in constant contact with the atrial wall [1][2][3][4][5], suggest that such electrodes may be more difficult to remove.…”