Preoperative Selection of the Best Fitting Electrode Length in Single-lead VDD Pacing by Transthoracic Echocardiography

Yin, Wei-Hsian
Jen, Hsu-Lung
Chiang, Meng-Cheng
Chuang, Yi-Cheng
Chang, Chung-Yi
Young, Mason-Shing
Wei, Jeng

Heart Center, Cheng-Hsin General Hospital, and Institute of Clinical Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan

Received June 4, 2001; Accepted August 15, 2001

Correspondence: Dr. Wei-Hsian Yin Heart Center, Cheng-Hsin General Hospital, No. 45, Cheng-Hsin Street, Taipei 112, Taiwan, R.O.C. Tel: 886-2-2826-1242; Fax: 886-2-2826-4532; E-mail: [email protected]

Acta Cardiologica Sinica 17(4):p 201-208, December 2001.

Background:

Reliable atrial sensing is a prerequisite for optimal single-lead VDD pacing. Previously proposed methods for choosing the proper distance between the lead tip and the floating atrial dipole (AV distance; AVD) were either unsatisfactory or invasive.

Methods:

We evaluate here an echocardiographic method for preoperative assessment of the optimal AVD for the individual patient in 68 consecutive cases. Before implantation of a VDD pacemaker, the internal dimension of the right heart chambers at end-diastole (RHIDd) was measured in the apical four-chamber view from the right ventricular apex to the posterior wall of the right atrium by transthoracic echocardiography. If the RHIDd was ≥ 13 cm, a lead with an AVD of 15.5/16 cm was used; if the RHIDd was < 13 cm, a lead with an AVD of 13/13.5 cm was chosen for implantation.

Results:

Using the described method, optimal atrial sensing, defined as minimum P-wave amplitude ≥ 1.0 mV, was obtained in 65/68 (96%) patients, and a lead with an AVD of 15.5/16 cm was implanted in 8/68 (12%) patients. In those three patients who had suboptimal atrial sensing, two had borderline RHIDd measurements; in the other patient, the reason for suboptimal sensing could not be well identified.

Conclusion:

In conclusion, the echocardiographic method allows a reliable and noninvasive preoperative assessment of the best fitting electrode length in single-lead VDD pacing. The criterion for selection of a lead with an AVD of 15.5 cm or 16 cm may be adjusted to 12.5 cm RHIDd.