Combining current of injury and P-wave sensing optimized right atrial active-fixation leads implantation

Pacing parameters may influence pacing lead life and pacemaker life. This study sought to determine whether different right atrial active-fixation lead implantation parameters are associated with chronic pacing performance.

A retrospective observational study was conducted on all consecutive patients implanted with an active-fixation atrial lead at our institution from July 2014 to October 2016. Atrial leads with a P-wave sensing of ≥2.0 mV, a pacing threshold of ≤1.0 V, and a lead impedance of 300-1,000 ohms were assigned as the optimized group, while atrial leads that did not meet these specifications were assigned as the conventional group. A total of 98 patients who received active-fixation atrial leads (55 patients were male, mean age was 63±12 years old) were studied, and the lead performance of 67 of these patients were optimized in 3 months.

In the multivariate analysis, current of injury [COI; COI_10min, odds ratio (OR): 0.296, 95% confidence interval (CI): 0.093-0.939, P=0.039] and P-wave sensing (P_10min, OR: 0.449, 95% CI: 0.265-0.762, P=0.003) were recorded at 10 minutes after lead fixation, and were considered predictors of lead optimized performance. The cut-off value of COI_10min and P_10min was 1.04 mV (sensitivity: 0.58 and specificity: 0.77) and 3.3 mV (sensitivity: 0.67 and specificity: 0.74), respectively, for predicting lead optimized performance after 3 months. COI_10min ≥1.04 mV and P_10min ≥3.3 mV were combined and considered as the predictable criteria, and the area under the ROC curve was 0.806 (sensitivity =0.70 and specificity =0.77).

Optimized atrial lead performance at 3 months was predictable from COI_10min ≥1.04 mV and P_10min ≥3.3 mV.