Dual-Chamber Pacemaker After Sinus Node Dysfunction and Enlarged Right Atrium

Arbas-Redondo, Emilio; Montes-Muñiz, Álvaro; Álvarez-Ortega, Carlos

doi:10.1161/circulationaha.121.054510

Cited by 1 publication

(2 citation statements)

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“…Some authors have demonstrated the relationship between a pre‐existing IAB and the development of new atrial high‐rate episodes (AHRE) during routine CIED interrogations 11–13 . On the other hand, atrial stimulation may also aggravate or even unmask an IAB, especially in patients with a preexisting atrial cardiomyopathy, further evidencing the conduction delay within the atria and hence the duration of the P‐wave 14,15 . This is particularly frequent when the atrial lead is positioned in the right atrial appendage (considered the “preferred placement location”).…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] On the other hand, atrial stimulation may also aggravate or even unmask an IAB, especially in patients with a preexisting atrial cardiomyopathy, further evidencing the conduction delay within the atria and hence the duration of the P-wave. 14,15 This is particularly frequent when the atrial lead is positioned in the right atrial appendage (considered the "preferred placement location"). In such cases, the traditional definition of IAB may not apply, due to the fact that the duration of the paced P-wave may be unusually long and with different morphology patterns.…”

Section: Introductionmentioning

confidence: 99%

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Paced P‐wave duration as a significant predictor for atrial high‐rate episodes in patients with cardiac implantable electronic devices

Campal

Arjona

Talavera

et al. 2022

Pacing Clinical Electrophis

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Background Atrial pacing (AP) can unmask or aggravate a preexisting interatrial block (IAB). The aim of our study was to determine whether AP is associated with the development of atrial high‐rate episodes (AHRE) during follow‐up. Methods Patients with dual‐chamber cardiac implantable electronic devices (CIEDs), no previous documented atrial fibrillation, and with a 6‐month minimum follow‐up were included. In all patients, sinus and paced P‐wave duration were measured. AHRE was defined as an episode of atrial rate ≥225 bpm with a minimum duration of 5 min, excluding those documented during the first 3 months after implantation. Results A total of 220 patients were included (75 ± 10 years, 61% male). After a mean follow‐up of 59 ± 25 months, 46% of patients presented AHRE. Mean paced P‐wave duration was significantly longer than the sinus P‐wave duration (154 ± 27 vs. 115 ± 18 ms; p < .001). Sinus and paced P‐waves were significantly longer in those who developed AHRE (sinus: 119 ± 20 vs. 112 ± 16; p = .006; paced: 161 ± 29 vs. 148 ± 23; p < .001). A paced P‐wave ≥160 ms was the best predictor of AHRE, especially those lasting >24 h (odds ratio [OR] 4.2 [95% confidence interval (CI)] [1.6–11.4]; p = .004). Conclusions AP significantly prolongs P‐wave duration and is associated with further development of AHRE. A paced P‐wave ≥160 ms is a strong predictor of AHRE and should be taken into consideration as a new definition of IAB in the presence of AP.

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Section: Introductionmentioning

confidence: 99%