Analysis of atrial sensed far-field ventricular signals: a reassessment

Accurate detection of the spontaneous far-field ventricular signal may be used to determine the ventricular activation, and hence, the interval from atrial stimulus to the ventricular R wave (AR interval) using a standard atrial pacing lead. This can be useful in developing a physiological atrial rate responsive (AAIR) pacemaker and in further improving DDD(R) pacing algorithms. In order to better characterize the atrial sensed far-field ventricular signal, 200 consecutive patients undergoing pacemaker implantation were studied. The amplitude of the far-field ventricular signal was significantly smaller than that of the atrial deflection. In all recordings, the slew rate of the atrial deflection was larger than that of the far-field ventricular signal. Subdivision of the recordings by electrode position, pocket location, or QRS duration on the surface ECG resulted in significantly different signal characteristics. The amplitude and slew rate of the far-field ventricular signal were significantly smaller in bipolar versus unipolar sensing. Atrial sensed far-field ventricular recordings could also be obtained in the case of ventricular pacing. Our results indicate that accurate sensing of the far-field ventricular signal from an atrial pacing lead is conceivable in most patients. The different signal characteristics in relation to parameters, such as electrode position, sensing mode, and pocket location, may be useful in determining the optimal conditions for signal sensing.