Effect of pacing rate on the human atrial strength-duration curve

The effect of rapid pacing on the atrial constant voltage stimulation threshold in humans has not been defined at rates applicable to those of antitachycardia pacing. The effect of pacing rate on the atrial strength-duration relation was determined in 10 patients at pacing rates between 125 and 300 beats/min to explore excitability over the range of rates used for permanent antitachycardia pacing systems. Two points that define the strength-duration curve were measured at each pacing rate: rheobase voltage--the lowest stimulus voltage that results in capture at a pulse duration of 2 ms; and chronaxie pulse duration--the threshold pulse duration at twice rheobase voltage. A permanent, tined, J-shaped pacing lead with a high current density and low polarization electrode was positioned in the right atrial appendage for cathodal stimulation. A constant voltage output, incorporating a fast recharge pulse designed to minimize electrode polarization, was used for stimulation. There was a significant increase in rheobase voltage (p = 0.009), chronaxie pulse duration (p = 0.001) and minimal threshold stimulus energy (p = 0.05) at pacing rates greater than 225 beats/min. A rheobase voltage greater than 5 V occurred in three patients at pacing rates greater than or equal to 275 beats/min. At a pacing rate of 300 beats/min, rheobase voltage had increased in 8 of 10 patients.(ABSTRACT TRUNCATED AT 250 WORDS)