Implantation of a dual chamber pacing and sensing single pass defibrillation lead

Dual-chamber ICDs are increasingly used to avoid inappropriate shocks due t o supraventricular tachycardios. Additionally, many ICD patients will proba bly benefit from dual chamber pacing. The purpose of this pilot study was t o evaluate the intraoperative performance and short-term follow-up of an in novative single pass right ventricular defibrillation lead capable of bipol ar sensing and pacing in the right atrium and ventricle. implantation of th is single pass right ventricular defibrillation lead was successful in all 13 patients (age 63 +/- 8 years; LVEF 0.44 +/- 0.26; New York Heart Associa tion [NYHA] 2.4 +/- 0.4, previous open heart surgery in all patients). The operation time was 79 +/- 29 minutes, the fluoroscopy time 4.7 +/- 3.2 minu tes. No perioperative complications occurred. The intraoperative atrial sen sing was 1.7 +/- 0.5 mV the artrial pacing threshold product was 0.20 +/- 0 .14 V/ms (range 0.03-0.50 V/ms). The defibrillation threshold was 8.8 +/- 2 .7 J. At prehospital discharge and at I-month and 3-month follow-up, atrial sensing was 1.9 +/- 0.9, 2.1 +/- 0.5, and 2.7 +/- 0.6 mV respectively, (P = NS, P < 0.05, P < 0.05 to implant, respectively), the mean atrial thresho ld product 0.79, 1.65, and 1.29 V/ms, respectively. In two patients, an int ermittent exit block occurred in different body postures. All spontaneous a nd induced ventricular arrhythmias were defected and terminated appropriate ly. Thus, in a highly selected patient group, atrial and ventricular sensin g and pacing with a single lead is possible under consideration of an atria l pacing dysfunction in 17% of patients.