Esophageal Electrocardiography

Utilization of programmers to measure interatrial conduction times and to program individual AV delay in DDD pacemaker patients.

B. Ismer (1), G. H. von Knorre (1), W. Vo?(1), W. Grille (2). (1) Universität Rostock Klinik und Poliklinik für Innere Medizin Abteilung Kardiologie Postfach 100888 D-18055 Rostock (2) Medizinische Klinik Städtisches Krankenhaus Kiel Chemnitzstr.33 D-241161 Kiel. Herzschrittmachertherapie und Elektrophysiologie. 9(4), 260-269, 1998. Background: In patients with DDD pacing systems, optimal AV delay is mainly determined by interindividually differing interatrial conduction time. If the latter is measured, individual optimal AV delay in VDD and DDD operation can be approximated by adding a representative, optimal interval of 70ms between left atrial depolarization and ventricular stimulus. In modern pacemakers providing telemetry, combination of right atrial telemetry and left atrial electrography via an esophageal lead could be used to measure interatrial conduction times for individual AV delay programming. Aims of the study: 1. To test the usefulness of telemetric right atrial electrograms and markers as a right atrial measuring reference. 2. To prove the possibility of implementing left atrial electrography into commercial programers. Methods: 1. Using computerized heart simulator, delays of the telemetric electrogram and markers were investigated in 12 DDD systems of 9 different companies. 2. To measure interatrial conduction times with programers, simultaneous recordings of right atrial electrogram and marker channel, resp., and the left atrial electrogram were performed using external hardware or internal software filtering of the esophageal lead. Results: Depending on the range of marker delay, pacing systems with real-time telemetry (delay 0-12ms) and orienting telemetry (delay gg12ms) were found. Facilitating left atrial electrogram recording into programers, interatrial time intervals can be measured in DDD and VDD operation in pacing systems with real-time telemetry. These results are prerequisits for individual AV delay programming with the programer. Then both can automatically be proposed, basic AV delay and the frequency modulated AV delay. Conclusion: Facilitating left atrial electrogram recording into pacemaker programers, interatrial conduction times can easily be measured for simplified physiologic AV delay programming during routine check-up.

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