Permanent Atrial Electrodes with Special Consideration to Transvenous Endocardial Forms

  • M. Kleinert


Atrial programmed permanent pacemaker therapy, using devices such as 1)atrial demand pacemakers (AAI or AAT, I, 2) atrial sensing ventricular stimulating, commonly referred to as P-wave synchronous pacemakers (VAT, I) and 3) A-V sequential or bifocal (DVI, 1) units offers the most physiologic form of bradycardia rhythm disturbance management (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) in properly selected cases. A key benefit of these modalities is the maintenance of the atrio-ventricular contraction sequence with the consequential homeostatic response (6). According to the investigations of Irnich (15), atrial programmed pacing should be considered in approximately 77% of all patients with symptomatic bradycardias. Evaluation of our patient population generally agrees with this figure. In 1976, 84 out of 98 (85%) were judged to be candidates for atrial programmed pacing. Of these, 54 actually received atrial devices. The disparity between the indication and utilization figures was due primarily to the absence of good, reliable, commercially available A-V sequential and P-wave synchronous pacemakers. Atrial electrode problems such as electrode instability and high thresholds, long considered to be the limiting factor to more widespread utilization of atrially programmed stimulation (16, 17), have been overcome to a large degree with new lead designs and techniques. The report which follows describes our experience with 147 atrial electrodes of 4 designs used over a period of 58 months.


Coronary Sinus Atrial Appendage Ventricular Pace Atrial Pace Complete Heart Block 
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© Martinus Nijhoff Publishers by, The Hague 1978

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  • M. Kleinert

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