Interatrial septum versus right atrial appendage pacing for prevention of atrial fibrillation

Zhang, L.; Jiang, Haiming; Wang, W.; Bai, Jing; Liang, Yanyan; Su, Ying; Ge, Junbo

doi:10.1007/s00059-017-4589-7

Cited by 13 publications

(15 citation statements)

References 42 publications

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“…However, studies showed conflicting results and the most optimal position is yet not solidly defined. 9 A pacing location at which the intra-atrial conduction delay is minimized may be most beneficial for the patient. In this study, we demonstrated that the reduction of TAT and cCDCB at BB is particularly achieved by LRA pacing, especially in patients with pre-existing conduction disorders at BB during SR.…”

Section: Discussionmentioning

confidence: 99%

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Mapping-guided atrial lead placement determines optimal conduction across Bachmann’s bundle: a rationale for patient-tailored pacing therapy

et al. 2023

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Aims Conventional right atrial appendage (RAA) pacing is associated with increased atrial activation time resulting in higher incidences of atrial tachyarrhythmia. Optimal pacing sites ideally shorten inter-atrial conduction delay, thereby decreasing atrial excitation time. We therefore examined the impact of programmed electrical stimulation (PES) from the right atrium (RA) and left atrium (LA) on the electrophysiological properties of Bachmann’s bundle (BB). Methods and results High-resolution epicardial mapping of BB was performed during sinus rhythm (SR) and PES in 34 patients undergoing cardiac surgery. Programmed electrical stimulation was performed from the RAA, junction of the RA with inferior caval vein (LRA), and left atrial appendage (LAA). Pacing from either the RAA or LAA resulted in, respectively, right- and left-sided conduction across BB. However, during LRA pacing in most patients (n = 15), activation started in the centre of BB. The total activation time (TAT) of BB during RAA pacing [63 (55–78) ms] was similar to that of SR [61 (52–68) ms, P = 0.464], while it decreased during LRA [45 (39–62) ms, P = 0.003] and increased during LAA pacing [67 (61–75) ms, P = 0.009]. Reduction of both conduction disorders and TAT was most often achieved during LRA pacing (N = 13), especially in patients who already had a higher amount of conduction disorders during SR [9.8 (7.3–12.3) vs. 4.5 (3.5–6.6)%, P < 0.001]. Conclusion Pacing from the LRA results in a remarkable decrease of TAT compared with pacing from the LAA or RAA. As the most optimal pacing site varies between patients, individualized positioning of the atrial pacing lead guided by mapping of BB may be one of the new frontiers for atrial pacing.

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Section: Discussionmentioning

confidence: 99%

“…Several studies demonstrated that pacing from the high atrial septum reduces the risk of AF, 2 , 5–8 but a large multi-centre study failed to show the benefit of atrial septal pacing. 9 It has been postulated that a pacing site with the smallest inter-atrial conduction delay reduces AF initiation and progression.…”

Section: Introductionmentioning

confidence: 99%

Mapping-guided atrial lead placement determines optimal conduction across Bachmann’s bundle: a rationale for patient-tailored pacing therapy

et al. 2023

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“…Although HASp is believed to improve interatrial conduction and reduce AF burden, HASp alone has failed to show consistent benefits 4,5 . One reason may be that the area of the HAS is difficult to implant using conventional tools.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported that right atrial appendage pacing (RAAp) exacerbates interatrial conduction delay (IACD), whereas high atrial septal pacing (HASp) may decrease AF incidence and duration 1–3 . However, other studies have shown that right atrial septal pacing alone did not suppress AF 4,5 . Previous methods of atrial lead implantation have used tined or screw leads.…”

Section: Introductionmentioning

confidence: 99%

Combined effects of high atrial septal pacing and reactive atrial antitachycardia pacing for reducing atrial fibrillation in sick sinus syndrome

Sumiyoshi

Tasaka

Yoshida

et al. 2023

Journal of Arrhythmia

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BackgroundIt is unknown whether atrial fibrillation (AF) burden varies by pacing site in patients with reactive atrial antitachycardia pacing (rATP). We aimed to compare AF burden in patients with high atrial septal pacing (HASp) via delivery catheter and right atrial appendage pacing (RAAp) in patients with sick sinus syndrome (SSS).MethodsWe retrospectively identified 109 patients with a history of paroxysmal AF and SSS who had received dual‐chamber pacemaker implantation between January 2017 and December 2019, of whom 39 and 70 patients had HASp and RAAp, respectively. rATP was initiated after a 1‐month post‐implantation run‐in period.ResultsPatients with HASp had a significantly shorter P‐wave duration during atrial pacing than those with RAAp (99.3 ± 10.4 vs. 116.0 ± 14.3 ms, p < .001). During the 3‐year follow‐up period, the incidence of an AF lasting longer than 1 or 7 days was significantly lower (hazard ratio [HR], 0.45; p = .016; HR, 0.24; p = .004) than in those with RAAp. The median time of AF/AT per day in the follow‐up periods was significantly shorter in the HASp group than in the RAAp group (10 vs. 18 min/day, p = .018). Atrial lead division did not occur in the HASp group during the follow‐up period.ConclusionsHASp via delivery catheter is as safe as RAAp, and HASp combined with rATP is effective for reducing AF burden in patients with SSS and paroxysmal AF.

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“…97 Zhang et al agreed that LAS pacing can reduce AF burden, and proved the safety of septal pacing. 98 Multisite atrial pacing mainly refers to biatrial pacing and RA bi-site pacing, and its electrophysiological mechanisms for the prevention of AF include the following: improving atrial depolarization and/or repolarization and ameliorating anisotropic conduction in the atrium, shortening the intra-atrial conduction time and restoring the synchronization of electrical activity in both atria, and shortening the atrial refractory period and reducing the dispersion of the atrial refractory period. 99,100 For patients with intra-atrial block, i.e., the P-wave time in the ECG >120 ms, the benefit of multisite atrial pacing is more obvious.…”

Section: Changing the Pacing Sitementioning

confidence: 99%

Review of the epidemiology, pathogenesis and prevention of atrial fibrillation after pacemaker implantation

Wu¹,

Xu²,

Tu³

et al. 2023

Adv Clin Exp Med

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Cardiac pacemaker implantation is an important treatment for symptomatic bradycardia. However, epidemiological data show that the incidence of atrial fibrillation (AF) is significantly higher in patients with implanted pacemakers than in the general population, which may be related to the preoperative presence of multiple risk factors for AF, improvement of diagnostic sensitivity and the pacemaker itself. The pathogenesis of AF after the implantation of pacemaker is related to cardiac electrical remodeling, structural remodeling, inflammation, and autonomic nervous disorder, which are induced by the pacemaker. Moreover, different pacing modes and pacing sites have various effects on the pathogenesis of postoperative AF. Recent studies have reported that reducing the proportion of ventricular pacing, improving the pacing site and setting up special pacing procedures might be highly useful in prevention of AF after pacemaker implantation. This article reviews the epidemiology, pathogenesis, influencing factors, and preventive measures regarding AF after pacemaker surgery.

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Interatrial septum versus right atrial appendage pacing for prevention of atrial fibrillation

Abstract: IAS pacing is safe and as well tolerated as RAA pacing. Although IAS pacing may fail to prevent permanent AF occurrence and recurrences of AF, it is able to not only improve interatrial conduction, but also reduce AF burden.

Cited by 13 publications

References 42 publications

Mapping-guided atrial lead placement determines optimal conduction across Bachmann’s bundle: a rationale for patient-tailored pacing therapy

Mapping-guided atrial lead placement determines optimal conduction across Bachmann’s bundle: a rationale for patient-tailored pacing therapy

Combined effects of high atrial septal pacing and reactive atrial antitachycardia pacing for reducing atrial fibrillation in sick sinus syndrome

Review of the epidemiology, pathogenesis and prevention of atrial fibrillation after pacemaker implantation

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