Method for Antegrade/Retrograde Conduction Discrimination Using A Standard Atrial Bipolar Lead

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Abstract
Significant differences between morphology, magnitude, and relative timing of antegrade and retrograde conduction were demonstrated on unipolar electrograms from a standard atrial bipolar J lead positioned in the right atrium in dogs. The morphology of the P wave sensed from the tip was more or less biphasic while the morphology of the P wave sensed from the ring was monophasic only and of lower frequency content. The unipolar‐ring P wave was attenuated in retrograde as compared with the antegrade. During retrograde conduction the unipolar‐ring signal returned to baseline earlier in time relative to the peak of the unipolar‐tip signal, than it did during antegrade conduction. Based on these differences a sensing circuit capable of discriminating between antegrade and retrograde conduction was built. This discriminator circuit, which relies on a standard lead and simple electronics, functioned reliably in trials in dogs and thus may prove to be practical for use in future pacemakers.