Far-field QRS complex sensing: prevalence and timing with bipolar atrial leads.

Sensing of far-field QRS complex through the atrial pacemaker lead may cause a number of pacemaker function disturbances, most of which are rarely seen with modern pulse generators. However, certain pulse generator algorithms will still be jeopardized by far-field QRS complex sensing. Intracardiac electrograms with markers were obtained by telemetry in 30 patients following implantation of a permanent bipolar atrial lead and a DDDR pulse generator. The occurrence and timing of far-field QRS complex sensing was studied at different atrial amplifier sensitivity settings. With paced ventricular complexes, QRS sensing was documented in all 30 cases at the maximum atrial sensitivity (0.1 mV). The median QRS complex sensing threshold was 0.3 mV, and the sensing window at high atrial sensitivities was 67-202 ms following the ventricular pacing impulse. In one case, QRS complex sensing was seen up to an atrial sensitivity of 1.5 mV. In 12 of 13 patients with 1:1 AV conduction, atrial sensing of spontaneously conducted ventricular complexes was seen (median sensing threshold 0.2 mV; the sensing window was -23 to 114 ms relative to the ventricular amplifier sensing event). Far-field QRS complex sensing was also found in all 12 patients in whom ventricular fusion complexes were obtained (median sensing threshold 0.2 mV; the window of sensing was 64-187 ms after the ventricular pacing impulse). Constant or intermittent QRS complex sensing via the atrial bipolar lead was thus universally demonstrable. It occurred in only a minority (20%) of patients at a sensitivity of 0.5 mV or less. Knowledge regarding the timing of the oversensing as related to the atrial sensitivity setting may aid in the design of algorithms of future pacemakers and cardioverter defibrillators.

Facilitation of DDD follow-up using the DDT mode.

To facilitate follow-up, modern dual chamber pacemakers provide a variety of diagnostic features like ECG interpretation channels and intracardiac electrograms. For evaluation of the sensing performance at rest and during exercise, for assessment of the presence of crosstalk, and for measurement of the retrograde conduction time, dual chamber triggered pacing, particularly the DDT mode, can be used alternatively or additionally in pacemakers equipped with this option. In contrast to ECG interpretation channels, ECG documentation is not required for evaluation of the sensing performance, because the triggered pulses serving as markers for sense events can also be seen on the monitor. Selection of the DDT mode not only as temporary but also as permanent program serves to facilitate pacemaker ECG interpretation for exercise tests and Holter recordings as well.