Advertisement

AAI and AAI-R Pacing: Clinical and Technical Aspects

  • H. Schüller
  • J. Brandt
  • T. Fåhraeus
Conference paper

Abstract

Permanent atrial pacing in sinus node disease was first successfully applied in 1964 [1]. Despite the fact that sinus node disease is today a common indication for permanent pacemaker treatment, the overall rate of atrial pacemaker implantations has remained low. Nevertheless, considerable experience has been gathered with permanent atrial stimulation. This is a review of aspects of atrial pacing that are relevant to the clinician.

Keywords

Atrioventricular Block Ventricular Pace Atrial Pace Cardiac Pace Atrioventricular Conduction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Silverman LF, Mankin HT, McGoon DC (1968) Surgical treatment of an inadequate sinus mechanism by implantation of a right atrial pacemaker electrode. J Thorac Cardiovasc Surg 55:264Google Scholar
  2. 2.
    Amikam S, Riss E (1979) Untoward hemodynamic consequences of permanent ventricular pacing associated with ventriculoatrial conduction. In:Meere C (ed) Proceedings of the Vlth world symposium on cardiac pacing. Pacesymp, Montreal, PP 15 - 6Google Scholar
  3. 3.
    Wirtzfeld A, Himmler FC, Klein G et al. (1982) Atrial pacing in patients with sick sinus syndrome:acute and long-term hemodynamic effects. In:Feruglio GA (ed) Cardiac pacing. Electrophysiology and pacemaker technology. Piccin Medica, Padova, P 651Google Scholar
  4. 4.
    Ausubel K, Furman S (1985) The pacemaker syndrome. Ann Intern Med 103:420PubMedGoogle Scholar
  5. 5.
    Badke FR, Boinay P, Covell JW (1980) Effects of ventricular pacing on regional left ventricular performance in the dog. Am J Physiol 238:H858PubMedGoogle Scholar
  6. 6.
    Askenazi J, Alexander JH, Koenigsberg DI et al. (1984) Alteration of left ventricular performance by left bundle branch block simulated with atrioventricular sequential pacing. Am J Cardiol 53:99PubMedCrossRefGoogle Scholar
  7. 7.
    Zile MR, Blaustein AS, Shimizu G, Gaasch WH (1987) Right ventricular pacing reduces the rate of left ventricular relaxation and filling. J Am Coll Cardiol 10:720CrossRefGoogle Scholar
  8. 8.
    Baller D, Wolpers H-G, Zipfel J et al. (1988) Comparison of the effects of right atrial, right ventricular apex and atrioventricular sequential pacing on myocardial oxygen consumption and cardiac efficiency:a laboratory investigation. PACE 11:394PubMedGoogle Scholar
  9. 9.
    Bedotto JB, Grayburn PA, Black WH et al (1990) Alterations in left ventricular relaxation during atrioventricular pacing in humans. J Am Coll Cardiol 15:658PubMedCrossRefGoogle Scholar
  10. 10.
    Sutton R, Kenny R-A (1986) The natural history of sick sinus syndrome. PACE 9:1110PubMedGoogle Scholar
  11. 11.
    Rosenqvist M, Brandt J, Schüller H (1988) Long-term pacing in sinus node disease:effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J 116:16PubMedCrossRefGoogle Scholar
  12. 12.
    Santini M, Messina G, Porto MP (1985) Sick sinus syndrome:single chamber pacing. In:Comez FP (ed) Cardiac pacing. Electrophysiology and tachyarrhythmias. Grouz, Madrid, P 144Google Scholar
  13. 13.
    Sasaki Y, Shimotori M, Akahane T et al. (1988) Long-term follow-up of patients with sick sinus syndrome:a comparison of clinical aspects among unpaced, ventricular inhibited paced, and physiologically paced groups. PACE 11:1575PubMedGoogle Scholar
  14. 14.
    Alpert MA, Curtis JJ, Sanfelippo JF et al (1987) Comparative survival following permanent ventricular and dual-chamber pacing for patients with chronic symptomatic sinus node dysfunction with and without congestive heart failure. Am Heart J 113:958PubMedCrossRefGoogle Scholar
  15. 15.
    Greenberg P, Castellanet M, Messenger J, Ellestad MH (1978) Coronary sinus pacing:clinical follow-up. Circulation 57:98PubMedGoogle Scholar
  16. 16.
    Moss AJ, Rivers RJ (1978) Atrial pacing from the coronary vein. Ten-year experience in 50 patients with implanted permanent pacemakers. Circulation 57:103PubMedGoogle Scholar
  17. 17.
    Schüller H, Brandt J (1983) Klinische Erfahrungen mit der Kohlenstoffelektrode SE 412 S in Kammer- und Vorhofposition (465 Patienten). In:Beyer J, Hemmer W (eds) Physiologische Stimulation mit Herzschrittmachern. Thieme, Stuttgart, P 68Google Scholar
  18. 18.
    Bernstein SB, van Natta BE, Ellestad MH (1988) Experiences with atrial pacing. Am J Cardiol 61:113PubMedCrossRefGoogle Scholar
  19. 19.
    Kleinert MP, Bartsch HR, Mühlenpfordt KG (1983) Comparative studies of ventricular and atrial stimulation thresholds of carbon-tip electrodes. In:Steinbach K et al (eds) Cardiac pacing. Proceedings of the Vllth world symposium on cardiac pacing. Steinkopff, Darmstadt, P 353Google Scholar
  20. 20.
    Brandt J, Attewell R, Fähraeus T, (1990) Atrial and ventricular stimulation threshold development:A comparative study in patients with a DDD pacemaker and two identical carbon-tip leads. PACE 13:859PubMedGoogle Scholar
  21. 21.
    Brandt J, Attewell R, Fähraeus T, Schüller H (1990) Acute atrial endocardial P wave amplitude and chronic pacemaker sensitivity requirements:relation to patient age and presence of sinus node disease. PACE 13:417PubMedGoogle Scholar
  22. 22.
    Shandling AH, Castellanet MJ, Thomas LA et al. (1990) The influence of endocardial electrode fixation status on acute and chronic atrial stimulation threshold and atrial endocardial electrogram amplitude. PACE 13:1116PubMedGoogle Scholar
  23. 23.
    Brandt J, Fähraeus T, Schüller H (1988) Far-field QRS complex sensing via the atrial pacemaker lead. I. Mechanism, consequences, differential diagnosis and countermeasures in AAI and VDD/DDD pacing. PACE 11:1432PubMedGoogle Scholar
  24. 24.
    Moss AJ, Rivers AJ Jr, Kramer DH (1974) Permanent pervenous pacing from the coronary vein. Long-term follow up. Circulation 49:222Google Scholar
  25. 25.
    Shandling AH, Castellanet MJ, Thomas L et al. (1989) Impaired activity rate responsiveness of an atrial activity-triggered pacemaker:the role of differential atrial sensing in its prevention. PACE 12:1927PubMedGoogle Scholar
  26. 26.
    Brandt J, Fähraeus T, Schüller H (1988) Far-field QRS complex sensing via the atrial pacemaker lead. II. Prevalence, clinical significance and possibility of intraoperative prediction in DDD pacing. PACE 11:1540PubMedGoogle Scholar
  27. 27.
    Rosen KM, Loeb HS, Sinno MZ et al. (1971) Cardiac conduction in patients with symptomatic sinus node disease. Circulation 43:836PubMedGoogle Scholar
  28. 28.
    Narula OS (1971) Atrioventricular conduction defects in patients with sinus bradycardia. Analysis by His bundle recordings. Circulation 44:1096PubMedGoogle Scholar
  29. 29.
    Rosenqvist M, Obel IWP (1989) Atrial pacing and the risk for AV block:is there a time for change in attitude? PACE 12:97PubMedGoogle Scholar
  30. 30.
    Sutton R (1989) The natural history of sick sinus syndrome and autonomic disturbances of heart rate control. New Trends Arrhythmias 5:125Google Scholar
  31. 31.
    Abbott JA, Hirschfeld DS, Kunkel FW, Scheinman MM (1977) Graded exercise testing in patients with sinus node dysfunction. Am J Med 62:330PubMedCrossRefGoogle Scholar
  32. 32.
    Holden W, McAnulty JH, Rahimtoola SH (1978) Characterization of heart rate response to exercise in the sick sinus syndrome. Br Heart J 40:923PubMedCrossRefGoogle Scholar
  33. 33.
    Valiin H, Edhag O (1980) Heart rate response in patients with sinus node disease compared to controls. Physiological implications and diagnostic possibilities. Clin Cardiol 3:391Google Scholar
  34. 34.
    Simonsen E (1987) Sinus node dysfunction. A prospective clinical study with special reference to true diagnostic value of ambulatory monitoring, exercise testing, and electrophysiologic studies. Thesis, University of Odense, Denmark. CA VI, OdenseGoogle Scholar
  35. 35.
    Johnston FA, Robinson JF, Fyfe T (1987) Exercise testing in the diagnosis of sick sinus syndrome in the elderly:implications for treatment. PACE 10:831PubMedGoogle Scholar
  36. 36.
    Prior M, Masterson M, Blackburn G et al. (1988) Critical identification of patients with sinus node dysfunction for potential sensor-driven pacing. PACE 11:512 (abstr)Google Scholar
  37. 37.
    Kallryd A, Kruse I, Ryden L (1989) Atrial inhibited pacing in the sick sinus syndrome:clinical value and the demand for rate responsiveness. PACE 12:954PubMedGoogle Scholar
  38. 38.
    Rognoni G, Bolognese L, Aina F et al. (1988) Respiratory-dependent atrial pacing, management of sinus node disease. PACE 11:1853PubMedGoogle Scholar
  39. 39.
    Rosenqvist M, Aren C, Kristensson BE et al. (1990) Atrial rate-responsive pacing in sinus node disease. Eur Heart J 11:537PubMedGoogle Scholar
  40. 40.
    Hatano K, Kato R, Hayashi H et al. (1989) Usefulness of rate responsive atrial pacing in patients with sick sinus syndrome. PACE 12:16PubMedGoogle Scholar
  41. 41.
    Brandt J, Fähraeus T, Schüller H (1990) Rate-adaptive atrial pacing (AAI-R):clinical aspects. In:Barold SS, Mugica J (eds) New perspectives in cardiac pacing, vol 2. Futura, Mount KiscoGoogle Scholar
  42. 42.
    Winter UJ, Alt E, Zegelman M et al. (1989) Clinical experience with 65 temperature-guided (TP) pacemakers Nova MR in Europe. PACE 12:1567 (abstr)Google Scholar
  43. 43.
    Daubert C, Ritter P, Mabo P et al. (1986) Physiological relationship between AV interval and heart rate in healthy subjects:applications to dual chamber pacing. PACE 9:1032PubMedGoogle Scholar
  44. 44.
    Ruiter J, Burgersdijk C, Zeeders M, Kee D (1987) Atrial Activitrax pacing. The atrioventricular interval during exercise. PACE 10:1226 (abstr)Google Scholar
  45. 45.
    den Dulk K, Lindemans FW, Brugada P et al. (1988) Pacemaker syndrome with AAI rate variable pacing:importance of atrioventricular conduction properties, medication, and pacemaker programmability. PACE 11:1226Google Scholar
  46. 46.
    Pouillot C, Daubert C, Mabo P et al. (1990) The lack of adaptation in PR interval to heart rate:a frequent limitation for A AIR pacing. PACE 13:504 (abstr)Google Scholar
  47. 47.
    Eagle KA, Mulley AG, Singer DE et al. (1986) Single-chamber and dual-chamber cardiac pacemakers. A formal cost comparison. Ann Intern Med 105:264PubMedGoogle Scholar

Copyright information

© Springer Verlag, Berlin Heidelberg 1993

Authors and Affiliations

  • H. Schüller
  • J. Brandt
  • T. Fåhraeus
    • 1
  1. 1.Department of Cardiothoracic SurgeryUniversity HospitalLundSweden

Personalised recommendations