A Prospective Randomized Study to Assess the Efficacy of Rate and Site of Atrial Pacing on Long‐Term Development of Atrial Fibrillation

Abstract

The Septal Pacing for Atrial Fibrillation Suppression Evaluation (SAFE) study is a single-blinded, parallel randomized designed multicenter study in pacemaker indicated patients with paroxysmal atrial fibrillation (AF). The objective is to evaluate whether the site of atrial pacing--conventional right atrial appendage versus low atrial septal--with or without atrial overdrive pacing will influence the development of persistent AF. The study will provide a definitive answer to whether a different atrial pacing site or the use of AF suppression pacing or both can give incremental antiarrhythmic benefit when one is implanting a device for a patient with a history of paroxysmal AF.

Prospective Randomized Study to Assess the Efficacy of Site and Rate of Atrial Pacing on Long-Term Progression of Atrial Fibrillation in Sick Sinus Syndrome

“…20 The protocol of SAFE has been published previously. 19 Briefly, SAFE was a sin ng g gle-e--bl bl lin in inde de ded, d, d, 2 2x2…”

“…It has bee ee en n n pr pr prop op opos os sed ed e t tha ha hat t t re e edu du duct ct ctio i n n n of of of t t tot ot otal al al at at a ri ri r al al al con on ondu du duct ct c io io ion n n ti ime me mes s s a a and nd nd d dis is spe pe pers rs rsio io ion n of atrial randomized controlled trial using clinical AF as the endpoint. The Septal Pacing for AF Suppression Evaluation (SAFE) study 19 was designed to address these uncertainties in pacing strategies for the secondary prevention of progression to persistent AF in patients with SSS. We hypothesized that RA septal pacing with an atrial pacing algorithm to ensure high percentage of atrial pacing can prevent the progression to persistent AF in patients with SSS and paroxysmal AF.…”

Incidence and Characteristics of Far-Field R-Wave Sensing in Low Right Atrial Septum Pacing

“…15 Therefore, low atrial septal (LAS) pacing has been recommended instead of RAA pacing to prevent ATA, 16 though this remains to be confirmed by randomized clinical trial. 17 However, because the LAS region is closer to the ventricle than the RAA, it may be associated with a higher likelihood of FFRW oversensing, 16,18 though the prevalence and characteristics of FFRW sensing associated with LAS pacing have not been formally studied.…”

“…chest roentgenogram, and (2) a negative P wave in the inferior leads and isoelectric or negative P wave in leads I, V5 and V6 during atrial pacing, on 12-lead ECG (Figures 1B,C). [16][17][18] Statistical Analysis Continuous variables are expressed as means ± standard deviation. Factors influencing the sensing of FFRW were determined using the chi-square test, and between-group comparisons were made by Mann-Whitney's U-test for continuous variables and by Fisher's exact test for dichotomous variables.…”

A Narrower Spacing of Electrodes and Atrial Septum Pacing

“…7-9 Although several small studies have demonstrated the clinical efficacy of this procedure, it has not been proven by a large randomized study. 10 The authors in this issue of the Journal 5 are to be highly recommended for demonstrating the next step in the clinical benefit of this particular method. Figure 1.…”