Acute atrial endocardial P wave amplitude and chronic pacemaker sensitivity requirements: relation to patient age and presence of sinus node disease.

Data are reviewed from 88 patients who received double, passive-fixation unipolar endocardial leads for DDD pacemaker treatment. Identical electrodes were used in the right atrium and the right ventricle. Intra-atrial P wave amplitudes, intraventricular QRS complex amplitudes, and atrial and ventricular pacing thresholds were determined at implantation. The intra-atrial P wave amplitudes were not significantly correlated to the intraventricular QRS complex amplitudes. No significant correlation was found between the atrial stimulation thresholds and the ventricular pacing thresholds. The intra-atrial P wave amplitude showed a significant inverse and logarithmic correlation with patient age (P = 0.007). Furthermore, patients with sinus node disease had significantly lower intra-atrial P wave amplitudes (P = 0.04) than patients without this abnormality. The acute atrial and ventricular pacing thresholds and the intraventricular QRS complex amplitude were not correlated to patient age or presence of sinus node disease. Patients requiring higher atrial amplifier sensitivity settings during follow-up were significantly older (P less than 0.05) than those in whom lower atrial sensitivities were sufficient. A postoperative attenuation of the atrial electrogram was detectable by sensitivity programming procedures in 29 of the patients (35%). This phenomenon did not significantly relate to patient age or presence of sinus node disease. No case of permanent atrial undersensing occurred. It is suggested that the lower intra-atrial P wave amplitudes in older patients and patients with sinus node disease reflect degenerative changes in the atrial myocardium. The statistical relations found appear to motivate special attention to atrial sensing in these patient groups.