Key result
Short tip-to-ring atrial leads prevent inappropriate mode switch from far-field sensing as effectively as conventional leads.
Why the study?
Does an atrial lead with a very short tip-to-ring spacing of 1.1 mm prevent false positive mode switch caused by far-field R-wave sensing without the need for individual PVAB optimization in patients receiving a dual chamber pacemaker?
RCT (n=204)
1:1 allocation in blocks of four
Yes
Does an atrial lead with a very short tip-to-ring spacing of 1.1 mm prevent false positive mode switch caused by far-field R-wave sensing without the need for individual PVAB optimization in patients receiving a dual chamber pacemaker?
Absolute Event Rate: 1% vs 2%
p-value: p=0.62
An atrial lead with a very short tip-to-ring spacing of 1.1 mm is as effective as a conventional lead with optimized programming at preventing inappropriate mode switch from far-field R-wave sensing, thereby simplifying pacemaker programming.
Short tip-to-ring atrial leads match optimized conventional leads for low FFS rates; leaves open broader adoption pending confirmatory trials.
OBJECTIVE: The AVOID-FFS (Avoidance of Far-Field R-wave Sensing) study aimed to investigate whether an atrial lead with a very short tip-to-ring spacing without optimization of pacemaker settings shows equally low incidence of far-field R-wave sensing (FFS) when compared to a conventional atrial lead in combination with optimization of the programming. METHODS: Patients receiving a dual chamber pacemaker were randomly assigned to receive an atrial lead with a tip-to-ring spacing of 1.1 mm or a lead with a conventional tip-to-ring spacing of 10 mm. Postventricular atrial blanking (PVAB) was programmed to the shortest possible value of 60 ms in the study group, and to an individually determined optimized value in the control group. Atrial sensing threshold was programmed to 0.3 mV in both groups. False positive mode switch caused by FFS was evaluated at one and three months post implantation. RESULTS: A total of 204 patients (121 male; age 73±10 years) were included in the study. False positive mode switch caused by FFS was detected in one (1%) patient of the study group and two (2%) patients of the control group (p = 0.62). CONCLUSION: The use of an atrial electrode with a very short tip-to-ring spacing avoids inappropriate mode switch caused by FFS without the need for individual PVAB optimization. TRIAL REGISTRATION: ClinicalTrials.gov NCT00512915.
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Kolb et al. (2012) conducted an RCT in Indication for dual chamber pacing (n=204). Atrial lead with 1.1 mm tip-to-ring spacing vs. Conventional atrial lead (10 mm spacing) with individually optimized PVAB was evaluated on Inappropriate mode switch due to far-field R-wave sensing within 3 months (95% CI -4% to 2%, p=0.62). An atrial lead with a very short tip-to-ring spacing of 1.1 mm and fixed PVAB avoided inappropriate mode switch due to far-field R-wave sensing as effectively as a conventional lead with optimized PVAB (1% vs 2%, p=0.62).
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