Combining Current Of Injury And P-wave Sensing Optimized Right Atrial Active-fixation Leads Implantation

Objective:To study the relationship between the current of injury(COI)and the pacing parameters recorded at the time of implantation and the postoperative 3-month pacing parameters.To explore the conditions for optimizing the placement of right atrial activefixation leads implantation.Methods: Ninety eight patients underwent fight right atrial active-fixation lead implantation in our department from July 2014 to October 2016 were enrolled in this study.According to pacing parameters recorded at the postoperative 3-month,Patients were divided into optimized lead performance group and conventional lead performance group.To study the correlation between the optimized lead performance at 3 months and the pacing parameters which recorded COI,pacing threshold,P-wave sensing,impedance in the right atrial leads at 0 minutes and 10 minutes of implantation.Results:(1)COI at 0 minute(COI0min,2.06{1.10}m V vs 1.29{1.42}m V,P=0.009)and10 minutes(COI10min,1.23{1.38}m V vs 0.71{0.61}m V,P=0.005)after lead fixation was significantly higher in optimized lead performance at 3 months compared to conventional lead performance.P-wave sensing measured at 0 minute(P0min,4.0{2.2}m V vs2.4{2.7} m V,P=0.005)and 10 minutes(P10min,4.0{2.7}m V vs 2.4{1.7}m V,P<0.001)after lead fixation was also significantly higher in optimized lead performance at 3months than in conventional lead performance.Pacing Threshold measured at 0minute(T0min,0.8{0.6}V vs 1.0{0.4}V,P =0.011)and Pacing Threshold measured at 10minute(T10min,0.7{0.4}V vs 0.8{0.5}V,P = 0.014)after lead fixation was significantly lower in optimized lead performance at 3 months than in conventional lead performance.(2)The optimized lead performance at 3 months was related with COI10min(OR=0.296,95%CI 0.093~0.939,P=0.039)and P10min(OR=0.449,95%CI0.265~0.762,P=0.003).(3)The cut-off value of COI10 min was 1.04 m V(sensibility 0.58, specificity 0.77),the cut-off value of P10 min was 3.3m V(sensibility 0.67,specificity 0.74)for predicting optimized lead performance at 3 months.Combine COI10 min ?1.04 m V and P10 min ?3.3m V as predictable criteria,the area under the ROC curve is 0.806(sensibility0.70,specificity 0.77).Conclusions: Chronic performance of the right atrial active-fixation leads is predictable using COI and P-wave sensing recorded at 10 minutes after lead fixation.COI10min?1.04 m V and P10min?3.3m V in the atrial leads are recommended to improve the lead performance at 3 months.