Permanent Left Atrial Pacing with a Specifically Designed Coronary Sinus Lead

Daubert, Claude; Leclercq, Christophe; Breton, Hervé; Gras, Daniel; Pavin, Dominique; Pouvreau, Yves; Verooij, Paul Van; Bakels, Noud; Mabo, Philippe

doi:10.1111/j.1540-8159.1997.tb05433.x

Cited by 40 publications

(18 citation statements)

References 9 publications

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“…To be successful, stable-pacing positions must be found for the left atrial lead within the coronary sinus (CS), whilst the second atrial lead is placed in the right atrial appendage. A lead for left atrial pacing via the CS, the Medtronic SP2188, has been designed with initial experience suggesting it is safe and highly effective if the distal tip could be positioned in the distal or middle part of the coronary sinus [2] . However, if placed in a proximal position within the CS this lead is unstable and likely to displace.…”

Section: Introductionmentioning

confidence: 99%

A comparison between passive and active fixation leads in the coronary sinus for biatrial pacing Initial experience

Levy¹

2000

Europace

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Section: Introductionmentioning

confidence: 99%

A comparison between passive and active fixation leads in the coronary sinus for biatrial pacing Initial experience

Levy¹

2000

Europace

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“…15 Clinical studies have shown that multisite atrial pacing may be effective in preventing the recurrence of AF. [4][5][6][7][8][9][10] There is marked shortening of the P wave duration with biatrial pacing in AF patients. 16 However, during biatrial pacing in AF patients, estimation of the incidence of AF by the memory function of the pacemaker is sometimes difficult because the reliability of the memory function is not clear and there is not a specially designed pacemaker for multisite atrial pacing.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies argued that multisite atrial pacing may prevent the recurrence of AF, [3][4][5][6][7][8][9][10] but in the application of biatrial pacing, we have often found double-counting of the intracardiac electrogram in the atrium because of interatrial conduction delay. The slow conduction in the right atrium and retrograde left atrial activation result in inhomogeneous activation of the left atrium and intra-and interatrial asynchrony.…”

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confidence: 99%

Double-Counting of Intracardiac Electrogram During Biatrial Pacing

Kobayashi

Ishikawa

Sumita

et al. 2004

Circ J

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lthough atrial fibrillation (AF) is the most commonly encountered arrhythmia and is associated with a high incidence of stroke and increased cardiovascular mortality, 1,2 in many cases it is still difficult to treat. Previous studies argued that multisite atrial pacing may prevent the recurrence of AF, [3][4][5][6][7][8][9][10] but in the application of biatrial pacing, we have often found double-counting of the intracardiac electrogram in the atrium because of interatrial conduction delay. The slow conduction in the right atrium and retrograde left atrial activation result in inhomogeneous activation of the left atrium and intra-and interatrial asynchrony. This conduction delay is important relation to the mechanisms that underlie AF, and the majority of patients with interatrial conduction delay have a high incidence of atrial tachyarrhythmias. 11 In the present study, we evaluated double-counting of the intracardiac electrogram in the atrium and used it to estimate the atrial pacing threshold. Methods Study PopulationThe study group comprised 10 patients (5 men, 5 women; Pacemaker ImplantationBiatrial dual-chamber pacemaker implantation was performed. The cephalic vein was used whenever possible, and the other 2 leads were inserted into the axillary vein by percutaneous puncture. First, the left atrial lead was introduced and positioned in the distal or mid site of the coronary sinus. After the lead was fixed, the ventricular lead and right atrial lead were introduced with passive fixation. We used the unipolar lead for the left atrium, and the bipolar leads for the right atrium and ventricle. The interelectrode distance of the bipolar lead was 17 mm. The coronary sinus lead was connected to the anodal port of the Y-connector and the distal electrode of the right atrial lead to the cathodal port. The connector was inserted into the atrial port of a DDDR pacemaker (Thera DR™ or Kappa™. Medtronic, Minneapolis, MN, USA). The ventricular lead was inserted into the ventricular port. The generator was positioned in the prepectoral pocket and the pocket was closed. Patient Follow-upArrhythmia control and device performance were assessed at outpatient visits. Intracardiac electrograms were recorded using the memory function of the implanted pacemaker devices, and the biatrial pacing threshold was checked. Background Biatrial pacing has a significant problem with memory function that misinterprets normal sinus rhythm as atrial tachyarrhythmias and in addition estimation of the atrial pacing thresholds (biatrial and uniatrial pacing thresholds) is sometimes difficult because of small P waves. Methods and ResultsThe intracardiac electrograms recorded by a pacemaker in 10 patients (age, 66.7±10.7 (SD) years) with implanted biatrial pacemakers were analyzed. Atrial sensing within the atrial refractory period after atrial pacing was counted in 6 of the 10 patients (timing of the double counting was 143±64 ms) when pacing failed in the left or right atrium. Atrial sensing within the atrial refractory period after atrial pa...

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“…Deshalb wurden spezielle Stimulationsalgorithmen entwickelt, die eine ª bzw. permanente Vorhofstimulation mit niedrigeren mittleren Schrittmacherfrequenzen erm6glichen [20,45] [14].…”

Section: Permanente Atriale Stimulationunclassified

Schrittmachertherapie bei Patienten mit Vorhofflimmern

Schuchert

Meinertz

1998

Herz

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Pacemaker therapy in patients with atrial fibrillation means the best current pacemaker therapy for patients with bradycardias with the aim to avoid the onset of atrial fibrillation and to establish DDD pacing despite of a history of atrial tachyarrhythmias. The newer application of pacing is the suppression of atrial arrhythmias in patients with medical refractory atrial tachyarrhythmias. Patients with slow ventricular rates and permanent atrial fibrillation should receive a VVI-pacemaker, if the bradycardias causes syncope, dizziness or a decrease of their exercise tolerance. In case of chronotropic incompetence the pacemaker should provide rate responsive pacing. Patients with sick sinus syndrome should receive an atrial (AAI) or dual-chamber (DDD) pacemaker, because patients with these in contrast to VVI-pacemakers develop less often atrial fibrillation and subsequent complications such as atrial thromboembolism. A dual-chamber or VDD-pacemaker--the latter connected to a VDD-single-lead--is indicated in patients with advanced AV-block. Atrial fibrillation occurs in 3 to 6% of the patients with no history of arrythmia and is, if pacemakers have no automatic mode switch, an often reason to program the devices to the VVI-pacing mode. Nowadays, most DDD(R)-pacemakers provide an automatic mode switch: During an atrial tachycardia the pacemaker switches to a VVI/VVIR mode and restores the initial DDD(R)-pacing mode with termination of the arrhythmia. In respect to the newer applications, one approach to prevent atrial tachyarrhythmias is permanent atrial pacing. As lower pacing rates of 80 to 90 ppm are usually needed and many patients hardly tolerate these pacing rates, new algorithms are under clinical investigation. Another approach is the simultaneous depolarization of the right and left atrium. Biatrial pacing is performed with one lead in the high right atrium and another lead in the coronary sinus. Another solution is bifocal atrial pacing with leads placed in the high right atrium and in the coronary sinus ostium. One effect of the new pacing techniques is to shorten interatrial conduction times. Therefore, biatrial pacing has become a therapy to prevent atrial arrhythmias deriving from delayed interatrial conduction times. As atrial reentry circuits seem to be important in atrial fibrillation, multisite atrial pacing is also performed in patients with medical refractory paroxysmal atrial fibrillation. Preliminary results suggest a more effective prevention of atrial fibrillation; nevertheless, these techniques should be still restricted to patients enrolled in clinical studies.

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Permanent Left Atrial Pacing with a Specifically Designed Coronary Sinus Lead

Cited by 40 publications

References 9 publications

A comparison between passive and active fixation leads in the coronary sinus for biatrial pacing Initial experience

A comparison between passive and active fixation leads in the coronary sinus for biatrial pacing Initial experience

Double-Counting of Intracardiac Electrogram During Biatrial Pacing

Schrittmachertherapie bei Patienten mit Vorhofflimmern

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