First Results of the Canadian and European Single Lead DDD Studies. A Report of Two Multicenter Studies on Vena Cava Atrial Stimulation (VECATS)

Abstract

The first results of a new, single lead DDD pacing system consisting of two bipolar combinations of floating atrial ring electrodes, with the proximal ring at the vena cava superior junction, and which can be used separately for atrial sensing and pacing (VECATS) are reported. Uncomplicated implantation of the pacing system was performed in 78 patients with VDD indications. Pacing and sensing parameters were measured at implantation, before discharge (days 1-3), at 1 and 3 months in various positions and during activity. Atrial pacing threshold (AT) and diaphragmatic stimulation threshold (DT) were 3.3 +/- 1.1 V and 7.2 +/- 2.2 at implant, and 4.3 +/- 0.5 and 7.9 +/- 1.1 V at 3 months, respectively, in the European group. In the Canadian group AT increased and DT decreased during follow-up, leaving a safety margin of 1 V. Reliable intraoperative atrial pacing was possible in 93% of patients. Failures were caused by no capture (3%) or AT > DT (4%). At 3 months, 54% of the atria were consistently paced. Atrial pacing failures were due to no atrial capture (8%), and AT > DT (38%). We conclude that atrial pacing was safe and initially possible in the majority of patients with the VECATS pacing system, though diaphragmatic stimulation became more prevalent over time, due to an increase in AT threshold and a decrease in DT.