Atrial stimulation by means of floating electrodes: a multicenter experience. The Multicenter Study Group

It is well established that single lead VDD pacing is a physiological, reliable, and easy to use mode of pacing. The major limitation of VDD pacing is the need of a normal sinus node function, confirming its indication to patients with isolated atrioventricular conduction disturbances. The Phymos 830 pacing lead was originally designed for VDD pacing in association with the Phymos MPS pulse generator; it has a floating atrial dipole with an interelectrode distance of 3 cm; the distal electrode is 11, 13, or 15 cm proximal to the tip. As a result of the incidental observation of atrial captures occurring at very low pulse amplitudes delivered from the floating dipole of this lead, a 13-center Italian study was initiated to test the systematic feasibility of this type of atrial pacing. Pacing parameters were set and strength-duration curves were acquired with the PSA Master 470 external device. The investigation was performed at pacemaker implant in 114 patients in the supine position. The tip of the electrode was positioned at the right ventricular apex and the atrial dipole at the site of the highest endocavitary signal. Atrial bipolar pacing was performed with the proximal electrode as the cathode. Stable atrial capture was obtained in 108 of 114 patients (94.7%); pacing threshold was < 3.5 V with a pulse width of 1 msec in 85 of 108 patients. Results of voltage threshold were: 2.99 +/- 1.25 and 2.59 +/- 1.13 V at pulse widths of 0.5 and 1 msec, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)