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Article: Programmed Atrial Sensitivity: A critical determinant in Atrial Fibrillation detection and optimal Automatic Mode Switching

TitleProgrammed Atrial Sensitivity: A critical determinant in Atrial Fibrillation detection and optimal Automatic Mode Switching
Authors
Issue Date1998
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, 1998, v. 21 n. 11 II, p. 2214-2219 How to Cite?
AbstractAutomatic mode switching (AMS) prevents tracking of paroxysmal atrial fibrillation (AF) in dual chamber pacing. The correct detection of AF can be affected by the programmed atrial sensitivity (AS). We prospectively studied the relationship between AS, AF undersensing, and AMS, using unfiltered bipolar intracardiac atrial electrograms recorded from 17 patients during sinus rhythm (SR) and in AF. Overall, 780 rhythms were recorded and replayed onto three dual chamber pacemaker models using different AMS algorithms (Thera DR 7940, Marathon DDDR 294-09, and Meta DDDR 1254), and the ventricular responses were measured. AS was randomly programmed in steps from the highest available AS to half of the mean atrial P wave amplitude (PWA), and the percentage of appropriate AMS responses (defined as a ventricular pacing rate at the expected AMS mode) were recorded. AMS efficacy was related to the programmed AS settings in an exponential manner. At low AS settings, a higher percentage of tests were associated with absence of, or with intermittent AMS and tracking of AF, whereas at higher AS, oversensing of noise during SR occurred. An optimal AS measured approximately 1.3 mV, representing about one-third of the PWA measured during SR, although oversensing of SR and undersensing of AF continued to occur in 14% of tests and time, respectively, due to the high variation in PWA during AF. Thus, a fixed AS cannot eliminate AF undersensing without inviting noise oversensing, suggesting the need for automatic adjustments of AS, or the use of a rate-limiting algorithm to prevent rate oscillation during intermittent AF sensing. In conclusion, AMS functions of existing pacemakers were significantly limited by the undersensing of AF and oversensing of noise. Proper adjustment of the AS is important to enable effective AMS during AF.
Persistent Identifierhttp://hdl.handle.net/10722/78470
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, MOen_HK
dc.contributor.authorChung, Fen_HK
dc.contributor.authorAyers, Gen_HK
dc.date.accessioned2010-09-06T07:43:15Z-
dc.date.available2010-09-06T07:43:15Z-
dc.date.issued1998en_HK
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 1998, v. 21 n. 11 II, p. 2214-2219en_HK
dc.identifier.issn0147-8389en_HK
dc.identifier.urihttp://hdl.handle.net/10722/78470-
dc.description.abstractAutomatic mode switching (AMS) prevents tracking of paroxysmal atrial fibrillation (AF) in dual chamber pacing. The correct detection of AF can be affected by the programmed atrial sensitivity (AS). We prospectively studied the relationship between AS, AF undersensing, and AMS, using unfiltered bipolar intracardiac atrial electrograms recorded from 17 patients during sinus rhythm (SR) and in AF. Overall, 780 rhythms were recorded and replayed onto three dual chamber pacemaker models using different AMS algorithms (Thera DR 7940, Marathon DDDR 294-09, and Meta DDDR 1254), and the ventricular responses were measured. AS was randomly programmed in steps from the highest available AS to half of the mean atrial P wave amplitude (PWA), and the percentage of appropriate AMS responses (defined as a ventricular pacing rate at the expected AMS mode) were recorded. AMS efficacy was related to the programmed AS settings in an exponential manner. At low AS settings, a higher percentage of tests were associated with absence of, or with intermittent AMS and tracking of AF, whereas at higher AS, oversensing of noise during SR occurred. An optimal AS measured approximately 1.3 mV, representing about one-third of the PWA measured during SR, although oversensing of SR and undersensing of AF continued to occur in 14% of tests and time, respectively, due to the high variation in PWA during AF. Thus, a fixed AS cannot eliminate AF undersensing without inviting noise oversensing, suggesting the need for automatic adjustments of AS, or the use of a rate-limiting algorithm to prevent rate oscillation during intermittent AF sensing. In conclusion, AMS functions of existing pacemakers were significantly limited by the undersensing of AF and oversensing of noise. Proper adjustment of the AS is important to enable effective AMS during 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.meshAlgorithmsen_HK
dc.subject.meshAtrial Fibrillation - diagnosis - therapyen_HK
dc.subject.meshCardiac Pacing, Artificial - methodsen_HK
dc.subject.meshElectrocardiographyen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshPacemaker, Artificialen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshSignal Processing, Computer-Assisteden_HK
dc.titleProgrammed Atrial Sensitivity: A critical determinant in Atrial Fibrillation detection and optimal Automatic Mode Switchingen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0147-8389&volume=11&spage=2214&epage=2219&date=1998&atitle=Programmed+atrial+sensitivity:+a+critical+determinant+in+atrial+fibrillation+detection+and+optimal+automatic+mode+switchingen_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.1540-8159.1998.tb01155.x-
dc.identifier.pmid9825321-
dc.identifier.scopuseid_2-s2.0-0031724365en_HK
dc.identifier.hkuros41412en_HK
dc.identifier.hkuros40414-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0031724365&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume21en_HK
dc.identifier.issue11 IIen_HK
dc.identifier.spage2214en_HK
dc.identifier.epage2219en_HK
dc.identifier.isiWOS:000077033800012-
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, MO=7401973887en_HK
dc.identifier.scopusauthoridChung, F=7202260638en_HK
dc.identifier.scopusauthoridAyers, G=7102015157en_HK

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