Key result
Two-step pacing threshold and current of injury protocol predicts persistent high thresholds with ~100% accuracy.
Why the study?
Practical criteria based on early intraoperative findings for identifying patients with persistent high pacing thresholds after atrial septal pacing with the 3830 lead have not been established.
Can intraoperative assessment using pacing threshold and current of injury at 5 minutes after fixation predict persistent high pacing thresholds with a 3830 lead?
Cohort (n=53)
Can intraoperative assessment using pacing threshold and current of injury at 5 minutes after fixation predict persistent high pacing thresholds with a 3830 lead?
A simple intraoperative two-step assessment using pacing threshold and current of injury at 5 minutes can effectively identify patients at risk of persistent high pacing thresholds when using a lumenless 3830 lead for right atrial septal pacing.
Persistent high thresholds post-fixation may resolve spontaneously; leaves open optimal monitoring and intervention thresholds in leadless pacing.
BACKGROUND: Atrial septal pacing with the 3830 lead is increasingly used, but some patients show high pacing thresholds (PT) immediately after fixation, and elevated thresholds may persist. Practical criteria based on early intraoperative findings for identifying such cases have not been established. METHODS: We retrospectively studied 53 consecutive patients who underwent cardiac implantable electronic device implantation with the 3830 lead positioned in the high right atrial septum. PT, sensing amplitude, impedance, and current of injury (COI) were measured immediately after fixation, at 5 and 10 min after fixation, post-procedure, at 1 week, and 3 months. The initial high-threshold group was defined as PT ≥ 1.5 V/0.4 ms immediately after fixation. In this group, we evaluated a two-step strategy using PT and COI at 5 min. The primary outcome was PT > 1.0 V/0.4 ms at 1 week. RESULTS: Of 53 patients, 26 were classified into the initial high-threshold group. In this group, PT improved from 2.000[1.750-2.438] V immediately after fixation to 0.750[0.500-0.875] V at 1 week (p < 0.001). Three patients (11.5%) met the primary outcome. PT ≥ 2.5 V/0.4 ms at 5 min yielded 100.0% sensitivity, 95.7% specificity, 75.0% positive predictive value, and 100.0% negative predictive value. In this cohort, adding a 5-min COI cutoff ≤ 2.1 mV to 5-min PT yielded 100.0% for all diagnostic metrics in this cohort. CONCLUSIONS: In this pilot study, most cases with high PT immediately after fixation improved within 1 week. A two-step assessment using PT and COI at 5 min after fixation may provide an exploratory framework for intraoperatively stratifying cases at risk of persistent high threshold at 1 week.
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Hayasaka et al. (2026) conducted a cohort in Cardiac implantable electronic device implantation (n=53). Intraoperative 5-minute pacing threshold and current of injury (COI) was evaluated on Pacing threshold > 1.0 V/0.4 ms at 1 week. A two-step intraoperative assessment adding a 5-minute current of injury cutoff ≤2.1 mV to a pacing threshold ≥2.5 V/0.4 ms yielded 100% sensitivity and specificity for persistent high threshold.
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