Key result
Preimplant RA volume ≥80 mL predicts inappropriate atrial sensing during VDD pacing with complete sensitivity.
Why the study?
Does pre-implantation echocardiography predict inappropriate atrial sensing in patients receiving single-lead VDD pacemakers?
Observational (n=21)
Does pre-implantation echocardiography predict inappropriate atrial sensing in patients receiving single-lead VDD pacemakers?
Effect estimate: Sensitivity 100%, Specificity 92%
p-value: p=<0.0001
Pre-implantation echocardiography, specifically a right atrial end-diastolic volume ≥80 mL, can accurately identify patients at high risk for inappropriate atrial sensing with single-lead VDD pacemakers, suggesting they may benefit from DDD pacing instead.
RA volume ≥80 mL may flag VDD sensing risk; hypothesis-generating for echocardiography-guided device selection.
Reliable atrial sensing is the prerequisite for restoration of atrioventricular synchrony in patients with single-lead VDD pacing systems. To determine echocardiographic variables associated with inappropriate atrial sensing, 21 consecutive patients with symptomatic second- or third-degree AV block and normal sinus node function were studied. Prior to implantation echocardiographic measurements of end-systolic and end-diastolic dimensions and volumes of the right atrium and right ventricle were performed. All patients underwent implantation of a Medtronic Thera VDD(d) pacemaker with a bipolar Medtronic Capsure electrode. A minimal amplitude of the unfiltered atrial electrocardiogram of > or =0.5 mV was required for permanent lead position and the atrial sensitivity was programmed below the lowest recorded value. Appropriate atrial sensing (atrial triggered ventricular paced complexes/total number of ventricular paced complexes) was assessed during 24-hour Holter monitoring and treadmill exercise testing 3 to 6 weeks after implantation. Inappropriate atrial sensing (<95% correct atrial synchronization during Holter registration and/or <97.5% during exercise testing) was present in nine patients. Right atrial volumes and the right ventricular end-diastolic volume was significantly higher, as compared to patients without inappropriate sensing (12 patients). The right atrial and diastolic volumes had the highest correlation with correct atrial sensing r = 0.83, P<0.0001). Using a postdefined cut-off value of > or =80 mL for the end-diastolic right atrial volume, sensitivity and specificity for inappropriate sensing was 100% and 92%, respectively. These findings show that preimplant echocardiography can identify patients with inappropriate sensing during VDD pacing, in whom DDD pacing should be considered.
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Cock et al. (1999) conducted an observational in Symptomatic second- or third-degree AV block and normal sinus node function (n=21). Preimplant echocardiography (end-diastolic right atrial volume) was evaluated on Inappropriate atrial sensing (<95% correct atrial synchronization during Holter registration and/or <97.5% during exercise testing) (Sensitivity 100%, Specificity 92%, p=<0.0001). Preimplant echocardiographic end-diastolic right atrial volume ≥80 mL predicted inappropriate atrial sensing during VDD pacing with 100% sensitivity and 92% specificity.