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Article: A comparative study on the behavior of three different automatic mode switching dual chamber pacemakers to intracardiac recordings of clinical atrial fibrillation

TitleA comparative study on the behavior of three different automatic mode switching dual chamber pacemakers to intracardiac recordings of clinical atrial fibrillation
Authors
Issue Date2000
PublisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1
Citation
Pace - Pacing And Clinical Electrophysiology, 2000, v. 23 n. 12 I, p. 2086-2096 How to Cite?
AbstractAutomatic mode switching (AMS) allows patients with dual chamber pacemakers who develop paroxysmal AF to have a controlled ventricular rate. The aim of this study was to (1) compare the rate-controlled behavior of three AMS algorithms in response to AF, in terms of speed and stability of response and resynchronization to sinus rhythm, and (2) compare the influence of pacemaker programming on optimal mode switching. We studied 17 patients (12 men, 5 women; mean age 59 ± 15 years) who developed AF during electrophysiological study. Unfiltered bipolar atrial electrograms during sinus rhythm and AF were recorded onto high fidelity tapes and replayed into the atrial port of three dual chamber pacemakers with different mode switching algorithms (Thera, Marathon, Meta). The Thera pacemaker uses rate smoothing, and mode switches occur when mean sensed atrial rate exceeds the predefined AMS rate (MR). Marathon mode switches after a programmable number of consecutive rapid atrial events (NR). Meta DDDR monitors the atrial rate by a counter for atrial cycles faster than the programmed AMS rate. It increases or decreases the counter if the atrial cycle length is shorter or longer than the programmed AMS interval, respectively. Mode switch occurs when the AF detection criteria are met (CR). A total of 260 rhythms were studied. NR was significantly faster than MR and CR (latency 2.5 ± 3 s vs 26 ± 7 s vs 15 ± 22 s, respectively, P < 0.0001). During sustained AF, MR resulted in the most stable and regular ventricular rhythm compared to NR or CR. In CR, ventricular rate oscillated between AMS and atrial tracking (cycle length variations: 44 ± 2 s vs 346 ± 109 s vs 672 ± 84 s, P < 0. 05). At resumption of sinus rhythm, MR resynchronized after 143 ± 22 s versus 3.4 ± 0.7 s for NR and 5.9 ± 1.1 s for CR, resulting in long periods of AV dissociation when a VVI/VVIR mode is used after AMS. Programming of atrial refractory periods did not affect AMS response, although the speed of AMS onset can be adjusted by programming of onset criteria in the Meta DDDR. AMS algorithms differ in their ability to handle recorded clinical atrial arrhythmias. The rapid-responding algorithm exhibits rate instability, whereas slow responding algorithm shows a long delay in response and risk of AV dissociation. Thus different instrumentation of AMS may have clinical implications in patients with dual chamber pacemakers who develop AF.
Persistent Identifierhttp://hdl.handle.net/10722/76398
ISSN
2015 Impact Factor: 1.156
2015 SCImago Journal Rankings: 0.662
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLeung, SKen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorLam, CTFen_HK
dc.contributor.authorTse, HFen_HK
dc.contributor.authorTang, MOIen_HK
dc.contributor.authorChung, Fen_HK
dc.contributor.authorAyers, Gen_HK
dc.date.accessioned2010-09-06T07:20:48Z-
dc.date.available2010-09-06T07:20:48Z-
dc.date.issued2000en_HK
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 2000, v. 23 n. 12 I, p. 2086-2096en_HK
dc.identifier.issn0147-8389en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76398-
dc.description.abstractAutomatic mode switching (AMS) allows patients with dual chamber pacemakers who develop paroxysmal AF to have a controlled ventricular rate. The aim of this study was to (1) compare the rate-controlled behavior of three AMS algorithms in response to AF, in terms of speed and stability of response and resynchronization to sinus rhythm, and (2) compare the influence of pacemaker programming on optimal mode switching. We studied 17 patients (12 men, 5 women; mean age 59 ± 15 years) who developed AF during electrophysiological study. Unfiltered bipolar atrial electrograms during sinus rhythm and AF were recorded onto high fidelity tapes and replayed into the atrial port of three dual chamber pacemakers with different mode switching algorithms (Thera, Marathon, Meta). The Thera pacemaker uses rate smoothing, and mode switches occur when mean sensed atrial rate exceeds the predefined AMS rate (MR). Marathon mode switches after a programmable number of consecutive rapid atrial events (NR). Meta DDDR monitors the atrial rate by a counter for atrial cycles faster than the programmed AMS rate. It increases or decreases the counter if the atrial cycle length is shorter or longer than the programmed AMS interval, respectively. Mode switch occurs when the AF detection criteria are met (CR). A total of 260 rhythms were studied. NR was significantly faster than MR and CR (latency 2.5 ± 3 s vs 26 ± 7 s vs 15 ± 22 s, respectively, P < 0.0001). During sustained AF, MR resulted in the most stable and regular ventricular rhythm compared to NR or CR. In CR, ventricular rate oscillated between AMS and atrial tracking (cycle length variations: 44 ± 2 s vs 346 ± 109 s vs 672 ± 84 s, P < 0. 05). At resumption of sinus rhythm, MR resynchronized after 143 ± 22 s versus 3.4 ± 0.7 s for NR and 5.9 ± 1.1 s for CR, resulting in long periods of AV dissociation when a VVI/VVIR mode is used after AMS. Programming of atrial refractory periods did not affect AMS response, although the speed of AMS onset can be adjusted by programming of onset criteria in the Meta DDDR. AMS algorithms differ in their ability to handle recorded clinical atrial arrhythmias. The rapid-responding algorithm exhibits rate instability, whereas slow responding algorithm shows a long delay in response and risk of AV dissociation. Thus different instrumentation of AMS may have clinical implications in patients with dual chamber pacemakers who develop AF.en_HK
dc.languageengen_HK
dc.publisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1en_HK
dc.relation.ispartofPACE - Pacing and Clinical Electrophysiologyen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAlgorithmsen_HK
dc.subject.meshAnalysis of Varianceen_HK
dc.subject.meshAtrial Fibrillation - physiopathology - prevention & controlen_HK
dc.subject.meshCardiac Pacing, Artificial - methodsen_HK
dc.subject.meshElectrophysiologyen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHemodynamicsen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshPacemaker, Artificialen_HK
dc.subject.meshSensitivity and Specificityen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleA comparative study on the behavior of three different automatic mode switching dual chamber pacemakers to intracardiac recordings of clinical atrial fibrillationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0147-8389&volume=23&issue=12&spage=2086&epage=2096&date=2000&atitle=A+comparative+study+on+the+behavior+of+three+different+automatic+mode+switching+dual+chamber+pacemakers+to+intracardiac+recordings+of+clinical+atrial+fibrillationen_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1540-8159.2000.tb00781.x-
dc.identifier.pmid11202252-
dc.identifier.scopuseid_2-s2.0-0034494854en_HK
dc.identifier.hkuros62085en_HK
dc.identifier.hkuros115126-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034494854&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume23en_HK
dc.identifier.issue12 Ien_HK
dc.identifier.spage2086en_HK
dc.identifier.epage2096en_HK
dc.identifier.isiWOS:000166539700013-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLeung, SK=7202044902en_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridLam, CTF=7402990956en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridTang, MOI=36832156000en_HK
dc.identifier.scopusauthoridChung, F=7202260638en_HK
dc.identifier.scopusauthoridAyers, G=7102015157en_HK

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