Simple electrocardiographic index for A4-wave amplitude of the VDD leadless pacemaker

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-04-01 DOI:10.1016/j.hroo.2025.01.006

Takafumi Oka MD, PhD , Koki Tanabiki , Takayuki Sekihara MD , Akira Yoshida MD, PhD , Kentaro Ozu MD , Tomoaki Nakano MD , Hibiki Mima MD , Yasuhiro Akazawa MD, PhD , Fusako Sera MD, PhD , Shigetaka Kusumoto , Masaki Takashina MD, PhD , Tomohito Ohtani MD, PhD , Yasushi Sakata MD, PhD

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Abstract

Background

A4-wave amplitude (A4-amplitude) is a crucial factor determining the percentage of atrioventricular synchrony (%AVS) in a mechanical sensing–based VDD leadless pacemaker (VDD-LP). We hypothesized that 12-lead electrocardiographic (ECG) parameters related to right atrial (RA) excitation could predict A4-amplitude.

Objectives

We aimed to investigate the relationship between A4-amplitude and 12-lead ECG parameters reflecting RA excitation and assess its predictive power for achieving an appropriate A4-amplitude associated with high %AVS.

Methods

This single-center, retrospective, observational study enrolled consecutive patients undergoing VDD-LP implantation. The relationship between A4-amplitude and the positive peak amplitude of the P wave in lead II (P2), the positive peak amplitude of the P wave in lead V₁ (V1P), and the sum of P2 and V1P (V1PP2) were assessed.

Results

Of the 67 patients undergoing VDD-LP implantation, 46 without atrial fibrillation bradycardia were enrolled. They had a data set of manual atrial mechanical sensing tests and 12-lead ECG. Among P2, V1P, and V1PP2, only V1PP2 was correlated with A4-amplitude (R²=0.10; P=.029). In 30 patients in VDD pacing mode, the median %AVS was 67.8%. The A4-amplitude cutoff for %AVS ≥ 67.8% was 3.2 m/s² (area under the curve [AUC] 0.81; P=.002). For A4-amplitude ≥ 3.2 m/s², V1PP2 had moderate predictive power (AUC 0.72; P=.007). In 30 patients without sick sinus syndrome, the predictive power of V1PP2 for A4-amplitude ≥ 3.2 m/s² was increased (AUC 0.80; cutoff value 110 μV; sensitivity 83%; specificity 71%; P=.011).

Conclusion

V1PP2, reflecting RA excitation, was related to A4-amplitude and had moderate predictive power. Notably, its predictive power increased when limited to patients without sick sinus syndrome. V1PP2 is a simple ECG predictor of A4-amplitude.

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VDD无铅起搏器a4波振幅的简单心电图指标

背景在基于机械传感的 VDD 无导联起搏器（VDD-LP）中，A4 波振幅（A4-amplitude）是决定房室同步百分比（%AFS）的关键因素。我们假设与右心房（RA）兴奋相关的 12 导联心电图（ECG）参数可以预测 A4 振幅。我们旨在研究 A4 振幅与反映 RA 兴奋的 12 导联心电图参数之间的关系，并评估其对实现与高 %AVS 相关的适当 A4 振幅的预测能力。评估了 A4 振幅与 II 导联 P 波正峰值振幅（P2）、V1 导联 P 波正峰值振幅（V1P）以及 P2 和 V1P 之和（V1PP2）之间的关系。他们的数据集包括手动心房机械传感测试和 12 导联心电图。在 P2、V1P 和 V1PP2 中，只有 V1PP2 与 A4 振幅相关（R2=0.10；P=0.029）。在 30 名采用 VDD 起搏模式的患者中，中位 %AVS 为 67.8%。AVS%≥67.8%的 A4 振幅临界值为 3.2 m/s2（曲线下面积 [AUC] 0.81；P=.002）。对于 A4 振幅≥ 3.2 m/s2，V1PP2 具有中等预测能力（AUC 0.72；P=.007）。在 30 位无病态窦房结综合征的患者中，V1PP2 对 A4 振幅≥ 3.2 m/s2 的预测能力有所提高（AUC 0.80；临界值 110 μV；灵敏度 83%；特异性 71%；P=.011）。值得注意的是，如果仅限于无病窦综合征的患者，其预测能力会增强。V1PP2 是预测 A4 波幅的简单心电图指标。

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