A simplified approach to temporary DDD pacing using a single lead, balloon-tipped catheter with overlapping biphasic impulse stimulation

Temporary DDD pacing offers significant hemodynamic benefits in emergency m anagement of bradyarrhythmias but is underused because of its complexity (t wo leads) and unreliability. Single lead VDD pacing with atrial sensing via a floating dipole is feasible, but atrial pacing is limited by high thresh olds and phrenic nerve stimulation (PNS). Overlapping biphasic impulse (OLB I) stimulation may avoid these problems. The authors designed a single lead balloon-tipped catheter for temporary tr ansvenous DDD pacing, incorporating noncontact atrial dipoles for OLBI stim ulation. This catheter was deployed using fluoro-scopic guidance in 74 pati ents (43 men, 31 women) with mean age 56.9 +/- 17.0 years. Pacing parameter s were assessed at implantation and follow-up. The median procedural time w as 6.6 (range 1.2-25.0) minutes and fluoroscopy time 1.9 (range 0.2-7.8) mi nutes. Stable VDD pacing was achieved in all cases. Atrial capture was achi eved in 73 of 74 cases with both modes at maximum output but was restricted by PNS at outputs below atrial capture threshold in 3 of 74 cases with OLB I and 10 of 74 cases with standard bipolar mode (P = 0.04). At outputs grea ter than or equal to 1.0 V above atrial threshold, reliable DDD pacing with out PNS was achieved and maintained in 67 (91%) of 74 patients in OLBI comp ared to 53 (72%) of 74 patients in bipolar mode (P = 0.003). Pacing paramet ers were stable during follow-up (median 53 hours, range 6-168 hours). In c onclusion, the single lead catheter with OLBI stimulation allows temporary VDD and DDD pacing without PNS to be achieved in > 90% of patients. This ra pid and convenient approach should facilitate DDD pacing in emergency setti ngs.