Fifteen Year Experience with Atrial Electrodes and Pacing
Two hundred and twelve patients were treated in our institution, since 1968, with long term atrial and atrio/ventricular sequential pacing utilizing different atrial electrodes. Indications included, I. atrial/ventricular arrythmia (16 pts.), 2. sick sinus syndrome with bradycardia (54 pts.), 3. sick sinus syndrome with brady/tachycardia (32 pts.), 4. intermittent heart block (73 pts.), 5. conversion from DVI to DDD pacing (8 pts.), 6. following open heart surgery (21 pts.), 7. miscellaneous (7 pts.). Forty-one (19%) of the 212 pts. had pre-existing congestive heart failure. Since 1968, a variety of atrial electrodes have been used; I. epicardial electrodes: a) modified (Lajos, 27 pts.), b) conventional (17 pts.), 2. transvenous electrodes; a) standard “J” (102 pts.), b) Mark I Lajos (14 pts.), and c) Mark II Lajos (52 pts.). Electrode related complications include, 7 instances of atrial dislodgement, 8 instances of pectoral muscle stimulation and 8 instances of diaphragmatic stimulation. Reprogramming was extensively employed with 64 instances of changes in rate (24), sensitivity, (8) output, (2) pulse width, (9) pulse interval (2) or modes (19). Atrial threshold characteristics were 1.53 ± 0.8911 mVolts, 3.17 ± 2.1909 mAmps, P wave 3.26 ± 2.3569 mVolts at time of implantation. Based on our experience, the evolution of modern electrode technology has provided safe and long term atrial and A-V sequential pacing. Contraindications are limited to refractory atrial flutter or fibrillation. The utilization of the single pass, double electrode combined with a multiprogrammable unit has added to our armamentarium, a new method of treating patients when pacing is required.
KeywordsRubber Plague Lewin
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