The effect of exercise on the atrial electrogram voltage in young patients

Atrial electrogram sensing is an important function in active individuals with permanently implanted bipolar dual chamber pacing systems. We undertook to determine the effect of vigorous exercise on the atrial electrogram size in 11 children and young adults (average age 12 years). Using a telemetry signal through a handheld programming wand, nine tracings were completely and clearly recorded for analysis. Six patients had tined/passive fixation atrial leads and three patients had screw-in/active fixation lead systems. All leads were bipolar. The atrial electrogram size for each patient was measured at rest and at each minute of exercise. The atrial electrogram size decreased with exercise from a mean of 5.08 mV to 3.44 mV (range 0.9-4.25 mV) (P = 0.002). The 1.64 mV mean decrease represented a 33.8% reduction (range 19%-56%) (P less than 0.001). There was no difference in the change in atrial electrogram size between the two lead types. Treadmill exercise testing with telemetric data of atrial electrograms showed a decrease in atrial electrogram size produced by exercise and may be helpful in determining appropriate atrial sensitivity settings in selected individuals. Because of the documented decrease in atrial electrogram size produced by exercise, we recommend obtaining maximal atrial electrograms at the time of implant and use of pacing systems that allow maximal flexibility in atrial sensing especially in athletically active individuals.