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Related Experiment Videos

Intermittent atrial sensing in a VDD pacemaker.

Vincenzo Carbone1, Scipione Carerj, Giuseppe Oreto

  • 1Department of Medicine and Pharmacology, University Hospital of Messina, Messina, Italy. oretogmp@tin.it

Journal of Electrocardiology
|September 22, 2007
PubMed
Summary
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This case report details intermittent atrial sensing failure in a patient with a single-lead VDD pacemaker. Pacemaker function improved when the atrial lead sensed signals during specific cardiac cycles, linked to mitral valve opening.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Single-lead VDD pacemakers are used for managing bradycardia, requiring reliable atrial sensing for optimal function.
  • Intermittent atrial sensing failure can lead to suboptimal pacing and potential hemodynamic compromise.

Observation:

  • A patient with a VDD pacemaker experienced intermittent failure to sense atrial activity, presenting as VVI pacing despite VDD device.
  • Intracardiac atrial electrograms were intermittently below the sensing threshold, causing missed atrial events.
  • Ventricular pacing was triggered by sinus P waves only within a critical interval (430-480 ms) post-QRS.

Findings:

  • Atrial sensing and appropriate ventricular pacing occurred when spontaneous atrial activity coincided with the mitral valve opening click.

Related Experiment Videos

  • Reduced atrial volume during mitral valve opening allowed the floating atrial lead to approximate the right atrial wall, improving signal capture.
  • This positional change of the atrial lead facilitated sensing of previously sub-threshold electrograms.

    • Implications:

    • Understanding lead behavior in relation to cardiac mechanics can explain intermittent sensing issues in pacemakers.
    • This observation may inform strategies for managing lead dislodgement or suboptimal positioning in pacemaker patients.
    • Further investigation into lead-tissue interaction and its impact on sensing thresholds is warranted.