Key result
Electrocardiographic V1PP2 predicts adequate A4-wave amplitude for atrioventricular synchrony with an AUC of ~0.72.
Why the study?
A4-wave amplitude is a crucial factor determining atrioventricular synchrony in mechanical sensing-based VDD leadless pacemakers, but simple ECG predictors of A4-amplitude have not been established.
Does the 12-lead ECG parameter V1PP2 predict A4-wave amplitude for mechanical sensing-based VDD leadless pacemakers in patients without atrial fibrillation?
Observational (n=46)
No
Does the 12-lead ECG parameter V1PP2 predict A4-wave amplitude for mechanical sensing-based VDD leadless pacemakers in patients without atrial fibrillation?
The sum of P-wave amplitudes in leads II and V1 (V1PP2) provides a simple preoperative ECG predictor of adequate A4-wave amplitude for VDD leadless pacemakers, especially in patients without sick sinus syndrome.
V1PP2 may aid ECG-based selection for VDD leadless pacemakers; leaves open prospective validation of sensing success.
Background A4-wave amplitude (A4-amplitude) is a crucial factor determining the percentage of atrioventricular synchrony (%AVS) in a mechanical sensing–based VDD leadless pacemaker (VDD-LP). We hypothesized that 12-lead electrocardiographic (ECG) parameters related to right atrial (RA) excitation could predict A4-amplitude. Objectives We aimed to investigate the relationship between A4-amplitude and 12-lead ECG parameters reflecting RA excitation and assess its predictive power for achieving an appropriate A4-amplitude associated with high %AVS. Methods This single-center, retrospective, observational study enrolled consecutive patients undergoing VDD-LP implantation. The relationship between A4-amplitude and the positive peak amplitude of the P wave in lead II (P2), the positive peak amplitude of the P wave in lead V 1 (V1P), and the sum of P2 and V1P (V1PP2) were assessed. Results Of the 67 patients undergoing VDD-LP implantation, 46 without atrial fibrillation bradycardia were enrolled. They had a data set of manual atrial mechanical sensing tests and 12-lead ECG. Among P2, V1P, and V1PP2, only V1PP2 was correlated with A4-amplitude ( R 2 =0.10; P =.029). In 30 patients in VDD pacing mode, the median %AVS was 67.8%. The A4-amplitude cutoff for %AVS ≥ 67.8% was 3.2 m/s 2 (area under the curve [AUC] 0.81; P =.002). For A4-amplitude ≥ 3.2 m/s 2 , V1PP2 had moderate predictive power (AUC 0.72; P =.007). In 30 patients without sick sinus syndrome, the predictive power of V1PP2 for A4-amplitude ≥ 3.2 m/s 2 was increased (AUC 0.80; cutoff value 110 μV; sensitivity 83%; specificity 71%; P =.011). Conclusion V1PP2, reflecting RA excitation, was related to A4-amplitude and had moderate predictive power. Notably, its predictive power increased when limited to patients without sick sinus syndrome. V1PP2 is a simple ECG predictor of A4-amplitude.
No takes yet. Share an insight, caveat, or question.
Oka et al. (2025) conducted an observational in Patients undergoing VDD leadless pacemaker implantation (n=46). V1PP2 (sum of positive P-wave peak amplitude in lead II and V1) was evaluated on Predictive power of V1PP2 for appropriate A4-wave amplitude (≥ 3.2 m/s2) associated with high atrioventricular synchrony (AUC 0.72, p=0.007). V1PP2, the sum of the positive P-wave peak amplitudes in leads II and V1, was significantly correlated with A4-wave amplitude and predicted values ≥3.2 m/s2 with an AUC of 0.72.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: