Far-field R wave oversensing in dual chamber pacemakers designed for atrial arrhythmia management: Effect of pacing site and lead tip to ring distance

Giuseppe Inama, Massimo Santini, Luigi Padeletti, Giuseppe Boriani, Gianluca Botto, Alessandro Capucci, Michele Gulizia, Renato Ricci, Paolo Rizzon, Fabio Ferri, Francesco Miraglia, Rossana Raneri, Andrea Grammatico

Research output: Contribution to journalArticlepeer-review


The aim of the study was to determine the incidence and practical implications of far-field R wave oversensing (FFRWO) and its association with pacing site and lead tip to ring spacing (TTRS) in implantable devices designed to diagnose and treat atrial tachyarrhythmias and programmed with a fixed and short postventricular blanking period. The study included 395 patients who were implanted with a DDDRP pacemaker and prospectively followed. At implant and follow-up visits FFRWO was assessed by analyzing lead electrical measures and atrial tachyarrhythmic episodes collected in the device diagnostics. During a median follow-up of 12 months 11 (2.8%) of 395 patients showed a clinically significant FFRWO that induced inappropriate detection or pacemaker malfunctioning. The atrial pacing site of these 11 patients was right atrium appendage (RAA) for 3 patients, representing 1.1% of 254 RAA patients, coronary sinus ostium (CSO) for 7 patients, representing 7.4% of 94 CSO patients (P <0.005 vs RAA), and lateral wall (LW) for 1 (2.9%) of 34 LW patients. The minimal value of the FFRWO to P wave ratio, measured at implant, associated with a clinically significant FFRWO was 0.6; therefore, a value of 0.5 was used as a cutoff to identify patients at risk of undesirable device behavior induced by FFRWO: there were 11 (9.6%) of 114 of RAA patients with short (≤ 10 mm) TTRS, 22 (18.8%) of 117 of RAA patients with long (≥ 17 mm) TTRS (P <0.05 vs short TTRS), 21 (30.6%) of 64 of CSO patients short TTRS (P <0.001 vs RAA patients with short TTRS) and 3 (30%) of 10 of CSO patients with long TTRS. The analysis showed that, despite the short postventricular blanking time, FFRWO inducing undesired functioning in AT500 pacemakers is infrequent (2.8% of patients). Compared to RAA, the CSO lead position was more frequently associated with FFRWO.TTRS <10 mm was associated with lower risk of clinically significant FFRWO in RAA.

Original languageEnglish
Pages (from-to)1221-1230
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Issue number9
Publication statusPublished - Sep 2004


  • Atrial tachyarrhythmia
  • Far-field oversensing
  • Pacing site
  • Tip to ring distance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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