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Performance of atrial tachyarrhythmia-sensing algorithms in dual-chamber pacing using a fixed long AV delay in patients with sinus node dysfunction

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Abstract

Aims

The aim of the study was to evaluate the performance of pacemakers (PM) atrial tachyarrhythmia (AT)-sensing algorithms in sinus node dysfunction (SND) patients with DDDR pacing programmed with a fixed long atrioventricular (AV) delay.

Methods

In a prospective study, a total of 60 patients with SND were implanted with a dual-chamber PM with two different algorithms for detection of ATs. The study was done with a 3 month data collection period retrieved from the memory of PM and with a 7 day external Holter recording period.

Results

In 13 of 16 (81 %) patients whose Holter recording revealed the presence of ATs, episodes of AT sensing were retrieved from the PM memory with electrograms verifications, confirming that the devices had detected the ATs. Very short ATs seen in Holter recordings were missed by the PM with three patients. However, with all these patients after 3 months of follow up period, there were recognized periods of ATs by the PM. With ten (17 %) patients, there were intermittent periods of undersensing by the PM although continuous atrial fibrillation (AF) was seen in the Holter recording. Retrograde conduction caused false AT detection due to repetitive non-reentrant ventriculoatrial synchronous rhythm (RNRVAS) in six (25 %) of the 24 patients with retrograde conduction.

Conclusions

Even with long AV delay, ATs can be accurately identified. However, transient undersensing of continuous AF and non-detection of very short AT episodes can still occur. Programming a long AV delay predisposes to RNRVAS which can cause false AT detection and symptoms in SND patients who have retrograde conduction.

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Acknowledgments

This study was supported by St. Jude Medical.

Conflict of interest

Sami Pakarinen received a fee from St. Jude Medical for designing this study. The authors have no other financial relationship with the sponsor.

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Authors and Affiliations

  1. Department of Cardiology, Meilahti Hospital, Helsinki University Central Hospital, Haartmaninkatu 4, P.O. Box 340, 00029 HUS, Helsinki, Finland

    Sami Pakarinen & Lauri Toivonen

Authors
  1. Sami Pakarinen
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  2. Lauri Toivonen
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Correspondence to Sami Pakarinen.

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Pakarinen, S., Toivonen, L. Performance of atrial tachyarrhythmia-sensing algorithms in dual-chamber pacing using a fixed long AV delay in patients with sinus node dysfunction. J Interv Card Electrophysiol 35, 207–213 (2012). https://doi.org/10.1007/s10840-012-9691-4

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  • DOI: https://doi.org/10.1007/s10840-012-9691-4

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