Efficacy of Low Interatrial Septum and Right Atrial Appendage Pacing for Prevention of Permanent Atrial Fibrillation in Patients With Sinus Node Disease

Abstract

Background-The role of pacing sites and atrial electrophysiology on the progression of atrial fibrillation (AF) to the permanent form in patients with sinus node dysfunction (SND) has never been investigated. The aim of the study was to investigate the relationship between atrial electrophysiology and the efficacy of atrial pacing at the low interatrial septum (IAS) or at the right atrial appendage (RAA) to prevent persistent/permanent AF in patients with SND. Methods and Results-The Electrophysiology-Guided Pacing Site Selection (EPASS) Study was a prospective, controlled, randomized study. Atrial refractoriness, basal and incremental conduction times from the RAA to the coronary sinus ostium were measured before implantation, and the difference (⌬CTos) was calculated. Patients with ⌬CTos Ն50 ms (study group) and those with ⌬CTos Ͻ50 ms (control group) were randomly assigned to RAA or IAS with algorithms for continuous atrial stimulation "on." The primary end point was time to development of permanent or persistent AF within a 2-year follow-up in the study group, IAS versus RAA. Data were analyzed by intention to treat. One hundred two patients (77Ϯ7 years, 44 mol/L) were enrolled, 69 (68%) in the study group and 33 (32%) in the control group. Of these, 97 ended the study, respectively, randomly assigned: 29 IAS versus 36 RAA and 18 IAS versus 14 RAA. After a mean follow-up of 15Ϯ7 (median, 17) months, 11 (16.6%) patients in the study group met the primary end point: 2 IAS versus 9 RAA (log rankϭ3.93, Pϭ0.047). Conclusions-In

Atrial Pacing Site and Atrioventricular Conduction in Patients Paced for Sinus Node Disease

“…This, compared with RAA pacing, may decrease the rate of unnecessary ventricular pacing . The EPASS study showed that LRAS is more effective that RAA pacing in the prevention of persistent AF in patients with SND and intraatrial conduction delays . Wang et al .…”

“…The low right atrial (RA) septum has been suggested as an alternate pacing site, instead of the RA appendage (RAA), for a more effective prevention of atrial fibrillation (AF) in selected pacemaker recipients presenting with sinus node disease (SND), though this remains controversial. [1][2][3][4][5][6] Episodes of AF can be triggered in presence of predisposing factors, such as sinus bradycardia, atrial ectopy, short-long-short sequences, increased dispersion of atrial refractoriness and locally inhomogeneous intraatrial conduction. In the MOST 7 and the SavePace trials, 8 a high cumulative percentage of ventricular pacing (cum%VP) in patients with SND was associated with a high incidence of AF, particularly when paced at the right ventricular (RV) apex.…”

Interatrial Block in the Modern Era

“…Studies have observed that in patients with sinus node disease and intra-atrial conduction delay at the posterior angle of Koch, low interatrial pacing is superior compared to right atrial appendage pacing in preventing progression to persistent or permanent AF and is associated with the shortest atrial activation time compared with other atrial septal pacing sites in patients with IAB [32, 69, 70]. …”

Heart Rate and Cardiovascular Responses to Commercial Flights: Relationships with Physical Fitness

“…Allostatic capacity can be monitored by the activity of the autonomic nervous system (ANS) through its regulation of the cardiovascular, respiratory and neuroendocrine systems (Verlato et al, 2011). The analysis of cardiovascular control, termed heart rate variability (HRV), has been as reported as an effective tool to identify changes in ANS activity (Task Force, 1996) in response to different stressors (Teisala et al, 2014).…”