Skip to main content
SpringerLink
Log in

Atriale Signalwahrnehmung mit wandständigen Elektroden und Floatingelektroden bei identischen Belastungen

Atrial sensing with fixed and floating electrodes at identical activities

  • Originalarbeit
  • Published:
Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassungen

Trotz Vorteile von Single-Lead-VDD-Systemen geht die Implantationshäufigkeit dieser Schrittmachersysteme bei Patienten mit symptomatischem AV-Block und erhaltenem Sinusrhythmus weiter zurück. Dadurch bedingt gibt es nur wenige vergleichende Daten bezüglich der atrialen Signalwahrnehmung über wandferne und wandständige Vorhofelektroden bei identischen Belastungen.

Ziel dieser Studie war es deshalb, die atriale Signalwahrnehmung über wandferne und wandständige Vorhofelektroden bei identischen Belastungsprotokollen (Rückenlage, Linksseitenlage, Sitzen, forcierte Atmung, Stehen, langsames Gehen, schnelles Gehen, Treppen steigen auf und ab, je 1,5 min) mittels Beat-to-beat-Analyse im Langzeit-EKG zu untersuchen.

Es wurden 42 Patienten in die Studie eingeschlossen (22 Patienten mit einem DDD- und 20 Patienten mit einem VDD-Schrittmacher). Bei 45% der DDD-Systeme und nur bei 20% der VDD-Systeme trat ein intermittierender Vorhofsensingverlust während der Belastung auf (p=0,0024). Intermittierendes atriales Undersensing in beiden Gruppen war signifikant häufiger in den ersten 15 s einer Belastung (p<0,001). Dabei reduzierte Floatingsensing die Häufigkeit des atrialen Undersensings in der Initialphase der Belastung signifikant im Vergleich zur wandständigen Signalwahrnehmung (p=0,0347).

Dieser Vorteil des Floatingsensings gegenüber wandständigem Sensing sowie die bekannte signifikant frühere Signalwahrnehmung über Floatingelektroden könnte in zukünftigen DDD-Schrittmachersystemen durch Kombination einer VDD-Elektrode mit einer wandständigen atrialen Elektrode von Nutzen sein.

Abstract

Despite advantages of single-lead VDD systems, the frequency of implantation of these pacemakers in patients with symptomatic atrioventricular block and normal sinus rhythm continues to decline. Therefore, data comparing the atrial sensing performance of floating and fixed electrodes at identical activities are rare.

The aim of the study was to investigate atrial sensing via floating and fixed atrial electrodes at identical activity levels (supine position, left side position, seated position, hyperventilation, standing, walking, fast walking, walking up and down stairs, for 1.5 min each) by beat-to-beat analysis in 24 h Holter ECG.

A total of 42 patients were included in the study (22 patients with a DDD system; 20 patients with a VDD system). In 45% of the DDD systems and only in 20% of the VDD systems an intermittent atrial undersensing during activity was recorded (p = 0.0024). The intermittent atrial undersensing in both groups was detected significantly more often in the first 15 s of an activity (p < 0.001). Floating sensing reduced the frequency of atrial undersensing in the initial phase of the activity significantly compared to atrial sensing by a fixed electrode (p = 0.0347).

This advantage of floating electrodes and the significant earlier atrial signal recognition by floating electrodes might be useful in future DDD pacemakers by combining a VDD electrode with a fixed atrial electrode.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Antonioli GE, Audoglio R, Brownlee RR (1991) Science, theory, and clinical considerations related to sensing atrial depolarization in single-lead-pacing. In: Antonioli GE, Aubert AE, Ector H (eds) Pacemaker leads. Elsevier, Amsterdam, pp 111–133

  2. Aubert AE, Ector H, De Geest H (1991) Single lead electrogram analysis. In: Antonioli GE, Aubert AE, Ector H (eds) Pacemaker leads. Elsevier, Amsterdam, pp 89–103

  3. Camm AJ, Sulke N, Edvardsson N et al (2007) Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: The AF-Therapy study. Europace 9:1110–1180

    Article  CAS  PubMed  Google Scholar 

  4. Fröhlig G, Blank W, Harbauer G et al (1986) Die Vorhofwahrnehmung von DDD-Schrittmachern - Follow-up von 167 Patienten. Herz-Kreislauf 4:164–174

    Google Scholar 

  5. Fröhlig G, Blank W, Schwerdt H et al (1988) A trial sensing performance of AV universal pacemakers during exercise. Pacing Clin Electrophysiol 11:47–60

    Article  PubMed  Google Scholar 

  6. Fröhlig G, Schwerdt H, Schieffer H, Bette L (1988) A trial signal variations and pacemaker malsensing during exercise: A study in the time and frequency domain. J Am Coll Cardiol 11:806–813

    Article  PubMed  Google Scholar 

  7. Gold MR, Hoffmann E, SAFARI Investigators (2006) Rationale and design of a randomized clinical trial to assess the role of overdrive and triggered prevention pacing therapies in reducing atrial fibrillation: The Study of Atrial Fibrillation Reduction (SAFARI). Am Heart J 152:231–236

    Article  PubMed  Google Scholar 

  8. Hartung D (1997) Device for stimulating excitable tissue. Patent PCT/DE96/02323

  9. Hartung WM (1996) Elektrodenarrangement. Patent PCT/DE 9700520; WO 97/31678

  10. Hartung WM (1997) Verfahren zur dynamischen Feldfokussierung bei der Stimulation von reizbarem Körpergewebe. Patent PCT/DE 19632706A1

  11. Hartung WM, Hartung D, Goette A et al (1996) Vorhofstimulation über flottierende Elektroden. Herzschr Elektrophys 7:17–25

    Google Scholar 

  12. Hartung WM, Hartung D, Saad H et al (2000) The importance of right atrial pacing electrode position and pacing configuration for intra-atrial and inter-atrial conduction times. J Interv Card Electrophysiol 4:405–413

    Article  CAS  PubMed  Google Scholar 

  13. Hartung WM (2004) Pacemaker for atrial sensing, atrial stimulation and termination of atrial tachycardias and auricular fibrillation, and a method of controlling a cardiac pacemaker. Patent US 20040236378

  14. Huang M, Krahn AD, Yee R et al (2004) Optimal pacing for symptomatic AV block: a comparison of VDD and DDD pacing. Pacing Clin Electrophysiol 27:19–23

    Article  PubMed  Google Scholar 

  15. Israel CW (1998) Determinanten des atrialen Sensings bei VDD-Single-Lead-Systemen. Herzschr Elektrophys 9:234–247

    Article  Google Scholar 

  16. Israel CW, Kruse IM, Van Mechelen R et al (1999) Results from the use of a preshaped lead for single-pass VDD/DDD stimulation. Pacing Clin Electrophysiol 22:1314–1320

    Article  CAS  PubMed  Google Scholar 

  17. Kong CW, Yu WC, Chen SA et al (2004) Development of atrial fibrillation in patients with atrioventricular block after atrioventricular synchronized pacing. Pacing Clin Electrophysiol 27:352–357

    Article  PubMed  Google Scholar 

  18. Lau CP, Leung SK, Lee IS (1996) Comparative evaluation of acute and long-term clinical performance of two single lead atrial synchronous ventricular (VDD) pacemakers: Diagonally arranged bipolar versus closely spaced bipolar ring electrodes. Pacing Clin Electrophysiol 19(11 Pt 1):1574–1581

    Article  CAS  PubMed  Google Scholar 

  19. Lemke B, Höltmann B, Lawo Th et al (1985) DDD-Schrittmacher: Häufigkeit und Relevanz von Vorhofwahrnehmungsstörungen durch Undersensing und AV-Knotenrhythmen. Herzschrittmacher 5:111–118

    Google Scholar 

  20. Nowak B, Middeldorf T, Voigtländer T et al (1998) How reliable is atrial sensing in single-lead VDD pacing: comparison of three systems. Pacing Clin Electrophysiol 21(11 Pt 2):2226–2231

    Article  CAS  PubMed  Google Scholar 

  21. Nowak B, Voigtländer T, für die DAVE-Multicenter Studiengruppe (1998) Aktuelle Ergebnisse der DAVE-Studie, DDD- and VDD-Evaluation: Eine prospektive randomisierte Studie zum Vergleich der DDD- und VDD-Stimulation bei AV-Block. Herzschr Elektrophys 9:82–83

    Article  Google Scholar 

  22. Nowak B, Voigtländer T, Himmrich E et al (1995) Cardiac output in single-lead VDD pacing versus rate-matched VVIR pacing. Am J Cardiol 75:904–907

    Article  CAS  PubMed  Google Scholar 

  23. Ogawa H, Ishikawa T, Matsushita K et al (2008) Effects of right atrial pacing preference in prevention of paroxysmal atrial fibrillation: Atrial Pacing Preference study (APP study). Circ J 72:700–704

    Article  PubMed  Google Scholar 

  24. Ovsyshcher IE, Katz A, Rosenheck S et al (1996) Single lead VDD pacing: Multicenter study. Pacing Clin Electrophysiol 19:1768–1771

    Article  Google Scholar 

  25. Rognoni G, Magnani A, Francalcci G et al (1991) Selective atrial sensing prevents endless loop tachycardias in single-pass lead VDD pacing. In: Antonioli GE, Aubert AE, Ector H (eds) Pacemaker leads. Elsevier, Amsterdam, pp 153–160

  26. Schuchert A, Rebeski HP, Peiffer T et al (2008) Effects of continuous and triggered atrial overdrive pacing on paroxysmal atrial fibrillation in pacemaker patients. Pacing Clin Electrophysiol 31:929–934

    Article  PubMed  Google Scholar 

  27. Tse HF, Lau CP, Leung SK et al (1996) Single lead DDD system: A comparative evaluation of unipolar, bipolar, and overlapping biphasic stimulation and the effects of right atrial floating electrode location on a trial pacing and sensing thresholds. Pacing Clin Electrophysiol 19(11 Pt 2):1758–1763

    Article  CAS  PubMed  Google Scholar 

  28. Wiegand UK, Bode F, Bonnemeier H et al (2003) Long-term complication rates in ventricular, single lead VDD, and dual chamber pacing. Pacing Clin Electrophysiol 10:1961–1969

    Article  Google Scholar 

  29. Wranicz JK, Chudzik M, Cygankiewicz I et al (2006) Pacing and sensing disturbances in patients with DDD pacemakers in the early period after implantation. Acta Cardiol 61:289–294

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Radiologie, Medizinischen Hochschule Hannover, Hannover, Deutschland

    D. Hartung

  2. Johanniter-Krankenhaus, Stendal, Deutschland

    L. Thiele

  3. Herzzentrum Hannover-Kirchrode, Tiergartenstr. 105, 30559, Hannover, Deutschland

    W.M. Hartung

Authors
  1. D. Hartung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W.M. Hartung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W.M. Hartung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hartung, D., Thiele, L. & Hartung, W. Atriale Signalwahrnehmung mit wandständigen Elektroden und Floatingelektroden bei identischen Belastungen. Herzschr. Elektrophys. 20, 39–42 (2009). https://doi.org/10.1007/s00399-009-0037-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00399-009-0037-6

Schlüsselwörter

Keywords

Search

Navigation