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Article: Single lead DDD system: A comparative evaluation of unipolar, bipolar, and overlapping biphasic stimulation and the effects of right atrial floating electrode location on atrial pacing and sensing thresholds

TitleSingle lead DDD system: A comparative evaluation of unipolar, bipolar, and overlapping biphasic stimulation and the effects of right atrial floating electrode location on atrial pacing and sensing thresholds
Authors
Issue Date1996
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, 1996, v. 19 n. 11 II, p. 1758-1763 How to Cite?
AbstractSingle lead DDD pacing using unipolar or bipolar stimulation is limited by high atrial threshold. Overlapping biphasic (OLBI) waveform stimulation via atrial floating ring electrodes may preferentially enhance atrial pacing and avoid diaphragmatic pacing. Single lead DDD pacing with OLBI atrial pacing was studied in 12 patients (6 men and 6 women; mean age 74 ± 7 years) with complete heart block. At implantation, atrial bipolar rings (area 27 mm2, separation 10 mm) were positioned at radiological defined high, mid, and low right atrial (RA) levels, and P wave amplitude and atrial and diaphragmatic pacing thresholds were determined in each position using unipolar, bipolar, and OLBI stimulation in random order. Although statistically insignificant, both the maximum and minimum sensed P wave amplitudes tended to be lower in the low RA position. Independent of the stimulation modes, minimum atrial pacing threshold occurred in the mid-RA. At mid-RA, the atrial pacing threshold was significantly lower with OLBI pacing compared with either unipolar or bipolar mode (3.9 ± 2.2 V vs 6.7 ± 3.5 V and 6.9 ± 3.5 V, P < 0.05). Although the diaphragmatic thresholds were similar, OLBI pacing modes in the mid-RA and final location significantly improved the safety margin for avoidance of diaphragmatic pacing compared with unipolar mode. There was no correlation between atrial pacing and sensing threshold. At predischarge testing, all but one patient who developed atrial fibrillation had satisfactory atrial capture and a stable atrial pacing threshold (day 0: 2.6 ± 1.1V vs day 2: 3.2 ± 1.3V, P = NS). However, diaphragmatic pacing occurred in four of 11 (36%) patients, especially in the upright position (sitting and standing). Our preliminary clinical results suggest that OLBI pacing via atrial floating ring electrodes can reduce the atrial pacing threshold. To optimize atrial pacing and sensing, the bipolar electrodes should be located at the mid-RA level first, although the high RA is an alternative. Despite significant improvements in the safety margin for diaphragmatic pacing with OLBI pacing, diaphragmatic stimulation remains a clinical problem.
Persistent Identifierhttp://hdl.handle.net/10722/76680
ISSN
2015 Impact Factor: 1.156
2015 SCImago Journal Rankings: 0.662
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTse, HFen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorLeung, SKen_HK
dc.contributor.authorLeung, Zen_HK
dc.contributor.authorMehta, Nen_HK
dc.date.accessioned2010-09-06T07:23:48Z-
dc.date.available2010-09-06T07:23:48Z-
dc.date.issued1996en_HK
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 1996, v. 19 n. 11 II, p. 1758-1763en_HK
dc.identifier.issn0147-8389en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76680-
dc.description.abstractSingle lead DDD pacing using unipolar or bipolar stimulation is limited by high atrial threshold. Overlapping biphasic (OLBI) waveform stimulation via atrial floating ring electrodes may preferentially enhance atrial pacing and avoid diaphragmatic pacing. Single lead DDD pacing with OLBI atrial pacing was studied in 12 patients (6 men and 6 women; mean age 74 ± 7 years) with complete heart block. At implantation, atrial bipolar rings (area 27 mm2, separation 10 mm) were positioned at radiological defined high, mid, and low right atrial (RA) levels, and P wave amplitude and atrial and diaphragmatic pacing thresholds were determined in each position using unipolar, bipolar, and OLBI stimulation in random order. Although statistically insignificant, both the maximum and minimum sensed P wave amplitudes tended to be lower in the low RA position. Independent of the stimulation modes, minimum atrial pacing threshold occurred in the mid-RA. At mid-RA, the atrial pacing threshold was significantly lower with OLBI pacing compared with either unipolar or bipolar mode (3.9 ± 2.2 V vs 6.7 ± 3.5 V and 6.9 ± 3.5 V, P < 0.05). Although the diaphragmatic thresholds were similar, OLBI pacing modes in the mid-RA and final location significantly improved the safety margin for avoidance of diaphragmatic pacing compared with unipolar mode. There was no correlation between atrial pacing and sensing threshold. At predischarge testing, all but one patient who developed atrial fibrillation had satisfactory atrial capture and a stable atrial pacing threshold (day 0: 2.6 ± 1.1V vs day 2: 3.2 ± 1.3V, P = NS). However, diaphragmatic pacing occurred in four of 11 (36%) patients, especially in the upright position (sitting and standing). Our preliminary clinical results suggest that OLBI pacing via atrial floating ring electrodes can reduce the atrial pacing threshold. To optimize atrial pacing and sensing, the bipolar electrodes should be located at the mid-RA level first, although the high RA is an alternative. Despite significant improvements in the safety margin for diaphragmatic pacing with OLBI pacing, diaphragmatic stimulation remains a clinical problem.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.meshAgeden_HK
dc.subject.meshAtrial Fibrillation - physiopathology - therapyen_HK
dc.subject.meshAtrial Function, Righten_HK
dc.subject.meshCardiac Pacing, Artificial - methodsen_HK
dc.subject.meshDiaphragmen_HK
dc.subject.meshElectric Stimulation - instrumentation - methodsen_HK
dc.subject.meshElectrocardiographyen_HK
dc.subject.meshElectrocardiography, Ambulatoryen_HK
dc.subject.meshElectrodesen_HK
dc.subject.meshEquipment Designen_HK
dc.subject.meshEquipment Safetyen_HK
dc.subject.meshEvaluation Studies as Topicen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHeart Block - physiopathology - therapyen_HK
dc.subject.meshHeart Rateen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshPacemaker, Artificialen_HK
dc.subject.meshPostureen_HK
dc.subject.meshSinoatrial Node - physiopathologyen_HK
dc.titleSingle lead DDD system: A comparative evaluation of unipolar, bipolar, and overlapping biphasic stimulation and the effects of right atrial floating electrode location on atrial pacing and sensing thresholdsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0030-8471&volume=19&issue=II&spage=1758&epage=1763&date=1996&atitle=Single+lead+DDD+system:+a+comparative+evaluation+of+unipolar,+bipolar,+and+overlapping+biphasic+stimulation+and+the+effects+of+right+atrial+floating+electrode+location+on+atrial+pacing+and+sensing+thresholdsen_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid8945035-
dc.identifier.scopuseid_2-s2.0-0029907771en_HK
dc.identifier.hkuros21188en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0029907771&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume19en_HK
dc.identifier.issue11 IIen_HK
dc.identifier.spage1758en_HK
dc.identifier.epage1763en_HK
dc.identifier.isiWOS:A1996VR45100018-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridLeung, SK=7202044902en_HK
dc.identifier.scopusauthoridLeung, Z=6506620133en_HK
dc.identifier.scopusauthoridMehta, N=11640902100en_HK

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