Atrial Function During Different Multisite Atrial Pacing Modalities in Patients With Bradycardia - Tachycardia Syndrome

Abstract

trial fibrillation (AF) is the most frequent arrhythmia observed in patients with an implanted pacemaker, and there are multiple factors for its etiology. [1][2][3] It has been shown that atrial pacing may have a preventive effect on AF recurrence. The antiarrhythmic effect of atrial pacing is not always immediate, but can be progressive in some patients, 4 and some pacing algorithms may also be useful. 5 Intra-and interatrial conduction disturbances are well-known factors predisposing to AF development and/or maintenance. Thus, the choice of atrial pacing site may play an important role in providing atrial electrical activation synchrony and diminishing the influence of abnormal atrial conduction on the incidence of AF. Some investigators have suggested that multisite atrial pacing (MAP), which incorporates 1 electrode in the right atrial appendage (RAA) and the other in the coronary sinus (CS) ostium area (dualsite atrial pacing) or in the mid-or distal CS (bi-atrial pacing), might be more beneficial than conventional RAA pacing. [6][7][8] Recently, our group proposed a novel method of MAP incorporating the Bachmann's bundle (BB) and CS ostium region. 9 This novel pacing modality presumes "double electrical resynchronization" of the left atrium (LA) and its antiarrhythmic effect has been shown in patients with AF. 9 However, up till now neither the optimal atrial pacing site nor the superiority of multisite over single-site atrial pacing has been ultimately determined.The aim of the study was to compare the hemodynamic effects of 2 MAP modalities and to determine the influence of the RA pacing lead positioning in the BB region compared with the typical RAA site on atrial contraction synchrony. It is presumed that beneficial hemodynamic effect of MAP would support its antiarrhythmic effect. Methods Patient PopulationWe studied 62 consecutive patients in whom MAP was conducted because of (1) sinus node dysfunction with class I or II indications for permanent cardiac pacing; (2) documented symptomatic AF recurrence (paroxysmal or persistent); (3) signs of advanced intra-and interatrial conduction delay: sinus P-wave duration ≥120 ms on the surface ECG; (4) no evidence of 2 nd or 3 rd degree atrioventricular (AV) block; and (5) Piotr Rucinski, MD*; Dariusz Kozlowski, MD, PhD; Grzegorz Raczak, MD, PhD; Andrzej Kutarski, MD, PhD* Background: Multisite atrial pacing (MAP) was introduced to improve atrial electrical synchrony and prevent recurrence of atrial fibrillation (AF). Methods and Results: In the present study there were 57 patients with sinus node disease, AF recurrence and prolonged P-wave on ECG with 2 MAP modalities. In all patients 1 lead was implanted in the coronary sinus (CS) ostium area. In the right atrial appendage (RAA)+CS group (28 patients) the other atrial lead was in the RAA, and in the BB+CS group (29 patients) in the Bachmann's bundle (BB) region. Tissue Doppler was used to register the electromechanical delay (EMD) in the atrial walls and estimate the atrial contraction synchrony. Cardiac o...

Single-Site Bachmann's Bundle Pacing Is Beneficial While Coronary Sinus Pacing Results in Echocardiographic Right Heart Pacemaker Syndrome in Brady-Tachycardia Patients

“…11-13 Recently, our group proposed a novel method of MSAp incorporating the BB region and CS ostium ("doubleresynchronization"). 17, 20 The clinical effects of this technique of MSAp in reducing AF recurrence have been promising, especially if used in combination with antiarrhythmic drugs; however, its main drawback is the number of leads that have to be implanted in the atrium.…”

Antiarrhythmic properties of atrial pacing

“…In another study of theirs, in patients with similar characteristics, pacing of the Bachmann's bundle and the coronary sinus ostium had no influence on the global hemodynamics, nevertheless it caused an earlier and more synchronized LA contraction and a reversed right-left contraction sequence. 44 Despite the encouraging results of some research projects, the usefulness of multisite pacing may be limited by the requirement for 2 atrial leads and a Y connector.…”