Toward optimizing the detection of atrial depolarization with floating bipolar electrodes

Some concepts derived from modern literature on the physics of cardiac muscle conduction regarding optimization of the design of electrode systems for detection of atrial depolarization and a preliminary clinical corroboration of the concepts are presented. The concepts of most import are 1) that the mechanical dimensions of sensing electrodes in all planes have to be as small as possible relative to the dimensions of the extracellular waveform dimensions associated with depolarization action potentials, and 2) that the distance between bipolar electrodes should be tuned to be greater than the dimensions of the extracellular waveform to avoid subtractive interference patterns associated with saltatory propagation in aging cardiac muscle. Additionally, in the practical application of chronic atrial sensing from a single lead for use in an implanted VDD pacing system, it is also important to consider electrode size and its effect on impedance level.