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Dual chamber pacing with a single-lead DDD pacing system
B Naegeli1, E Straumann, A Gerber
1Cardiac Unit, Department of Internal Medicine, Stadtspital Triemli, Zürich, Switzerland.
Pacing and Clinical Electrophysiology : PACE
|August 24, 1999
Summary
This study shows a new single-pass DDD lead enables short- and long-term atrioventricular sequential pacing. While effective, higher atrial pacing thresholds suggest electrode improvements are needed for optimal energy use and reduced phrenic nerve stimulation.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Single-lead VDD pacing success has spurred interest in single-lead DDD pacing.
- Previous attempts using floating atrial dipoles for single-lead DDD pacing were unsatisfactory due to high current drain.
Purpose of the Study:
- To evaluate the feasibility and short- and long-term stability of atrioventricular sequential pacing using a novel single-pass DDD lead.
Main Methods:
- Eight patients with symptomatic high-degree AV block and intact sinus node function received the new single-pass DDD lead and a DDDR pacemaker.
- Device function (VDD and DDD modes) was assessed at implantation, discharge, and at 1, 3, and 6 months post-implantation.
Main Results:
- The single-pass DDD lead demonstrated feasibility for both short- and long-term DDD pacing.
- Atrial stimulation thresholds increased during follow-up, averaging 3.4+/-0.4 V at 6 months.
- Phrenic nerve stimulation occurred in 38% of patients at discharge, decreasing to 13% during follow-up. Intermittent atrial lead impedance was noted in one patient.
Conclusions:
- The novel single-pass DDD lead is a viable option for short- and long-term atrioventricular sequential pacing.
- Further optimization of atrial electrodes is recommended to lower pacing thresholds, reduce energy consumption, and minimize phrenic nerve stimulation.