Journal Article

Placement of atrial pacing leads during atrial fibrillation

H. J. Marshall, M. J. Griffith and M. D. Gammage

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 1, issue 2, pages 131-134
Published in print April 1999 | ISSN: 1099-5129
Published online April 1999 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.1998.0030
Placement of atrial pacing leads during atrial fibrillation

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Aims

To assess the feasibility of placing permanent atrial pacing leads during atrial fibrillation (AF) and whether such leads function satisfactorily.

Methods and Results

Prospective study of 17 consecutive patients in whom permanent atrial leads were positioned during an episode of paroxysmal AF. Fluoroscopic pos-ition (‘figure of 8’ or side-to-side movement and anterior position in RAO projection), lead impedance (>300 but <1000 ohms) and intracardiac electrogram (average peak to peak amplitude >1 mV) were used to define an acceptable lead position. At 8 weeks post implant we measured: pulse duration pacing threshold at 5 V; lead impedance at 5 V and 0·5 ms; intracardiac electrogram (EGM) signal amplitude. At the end of the study we reviewed patients to establish whether AF had become permanent. In all patients, follow-up demonstrated satisfactory lead function. All leads had impedances between 300 and 1000 ohms. Pacing thresholds were all <0·1 ms at 5 V. Mean atrial EGM amplitude seen in sinus rhythm was 3·3 mV (range 1·2–8·4); in patients where all follow-up was in AF it was 2·1 mV (range 1·5–2·5). Nine patients (53%) developed permanent AF.

Conclusion

Placing atrial leads during AF is feasible using the technique described. However, some patients progress to chronic AF, eliminating the benefits of atrial pacing.

Keywords: Atrial fibrillation; permanent pacing leads; implantation technique; atrial electrograms; atrial sensing by pacemakers

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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