Prediction of permanent atrial sensing by preoperative esophageal atrial wave evaluation

Atrial undersensing is a common problem in permanent atrial and dual chamber pacing. The purpose of this study was to evaluate the relationship between transesophageal atrial wave (EsAW) and right atrial endocavitary (RA). Forty-seven patients 72 +/- 9.7 years of age, with symptomatic bradyarrhythmias were studied. The EsAW was filtered with a high pass filter of 10 Hz (Arzco preamplifier-filter), using 1, 2, and 3 cm bipolar transesophageal catheters. Atrial bipolar floating 1, 2, and 3 cm electrograms from the high RA (HRA) and from the mid RA (MRA), as well as unipolar electrograms from the right auricle (RAUR) were recorded 1 day later. Comparison by paired t-test showed no significant differences between EsAW and bipolar sensing in RA, but significant differences between EsAW and RAUR (P = 0.0001). The results of the Spearman correlation coefficient for sensing (mV) for EsAW, HRA, and MRA, respectively, were: 1 cm, 1.8 +/- 0.9, 1.7 +/- 0.9, and 1.9 +/- 0.9 (z > 3.5; P < 0.0003); 2 cm, 2.2 +/- 0.9, 1.9 +/- 0.8, and 2.1 +/- 0.9 (z > 2.3; P < 0.03); 3 cm, 2.1 +/- 1, 2 +/- 0.9, and 2.2 +/- 1.0 (z > 2.9; P < 0.003); and the result for the monopolar RAUR was 3.0 +/- 1.0 (z < 1.4; P > 0.17). These findings, if confirmed in more patients, indicate that preoperative EsAW recording could be useful in estimating the quality of bipolar floating electrograms from the RA but not of unipolar RAUR.