Is Dual Site Better Than Single Site Atrial Pacing in the Prevention of Atrial Fibrillation?

Leclercq, J. F.; Sisti, Antonio De; Fiorello, Pierre; Halimi, Franck; Manot, Stephanie; Attuel, P

doi:10.1111/j.1540-8159.2000.tb00783.x

Cited by 51 publications

(27 citation statements)

References 25 publications

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“…Biatriyal pacing gibi bu süreyi kısaltmaya yönelik tedavi seçenekleri bir çok çalışmada irdelenmiştir ve interatriyal ileti süresinde uzama tespit edilen hasta grubunda, bu yöntemin AF rekürrensinde anlamlı azalma sağla-dığı gösterilmiştir (30)(31)(32).…”

Section: Discussionunclassified

Value of interatrial conduction time and P wave dispersion in prediction of atrial fibrillation following coronary bypass surgery

Ceylan¹,

Bayata²,

Yeşìl³

et al. 2010

Anadolu Kardiyol Derg

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Koroner baypas cerrahisi sonrası atriyal fibrilasyonu öngörmede interatriyal ileti süresi ve P dalga dispersiyonunun değeriValue of interatrial conduction time and P wave dispersion in the prediction of atrial fibrillation following coronary bypass surgery Özgün Araşt›rma Original Investigation 495Yaz›şma Adresi/Address GirişAtriyal fibrilasyon (AF) kardiyak cerrahi sonrası görülen aritmik komplikasyonların başında gelir. Operasyon öncesi alınan tüm önlemlere ve gelişen cerrahi tekniklere rağmen halen %20 ile %40 gibi yüksek oranlarda görülmektedir (1). Postoperatif AF gelişimi ile ilgili birçok risk faktörü ve prediktör belirlenmiştir. Önceden var olan AF öyküsü, ileri yaş, yapısal kalp hastalıkları gibi cerrahi ile ilişkisiz AF oluşumunda da etkili faktörlerin yanın-da, beta-blokerlerin kesilmesi, uzamış operasyon ve kardiyopulmoner baypas (KPB), sağ koroner arter tutulumu, intraaortik balon pompası (İABP) kullanımı gibi cerrahi ile ilişkili faktörler bunlardan bazılarıdır (2, 3).Atriyal ileti ve refrakterlik özelliklerindeki değişimlerin AF oluşumu ile ilişkili olduğu gösterilmiştir (4, 5). Atriyumlarda heterojen elektriksel iletim ve heterojen refrakterliğin göstergesi olan ve en uzun ile en kısa P dalga süreleri arasındaki fark olarak tanımlanan P dalga dispersiyonunun (PDD) değişik hasta popü-lasyonlarında gerek AF oluşumunu gerekse de kardiyoversiyon sonrasında AF rekürrensini öngörmede kullanılabileceğine dair yayınlar vardır (4, 6, 7). Öte yandan PDD'nin hesaplanmasında kullanılan en uzun P dalga süresinin bozulmuş interatriyal ileti ile ilişkili olduğu bilinmektedir (6). Paroksismal AF'li hastalarda bozulmuş interatriyal ileti ve uzamış interatriyal ileti süresi gös-terilmiş olmakla birlikte bu parametrenin değişik hasta popülas-yonlarında AF gelişimini öngörücü gücü konusunda yeterli bilgi yoktur (5, 8). Bu nedenle bu çalışmada, daha önce paroksismal AF gelişimini öngördüğü çeşitli çalışmalarla gösterilen ikincil değişken PDD'ye ilave olarak PDD'nin oluşumuna katkıda bulunan ve üzerinde yeterince çalışılmamış olan birincil değişken İAİS ile koroner arter baypas cerrahisi (KABC) sonrası AF gelişi-mi arasındaki ilişki araştırılmıştır. Yöntemler Hasta popülasyonuHastanemize elektif KABC için yatan ve sinüs ritminde olan 81 hasta bu prospektif, gözlemsel çalışmaya alındı. Atriyal fibrilasyon öyküsü, ileti sistemi hastalığı, ritim üzerine etkili endokrin hastalığı, kronik böbrek yetmezliği, orta-ciddi kapak hastalığı ve ciddi hipertrofi gibi ek yapısal kalp hastalığı olan, ejeksiyon fraksiyonu %55' in altında, elektrolit dengesizliği olan, beta-bloker dışı antiaritmik ilaç kullanan, KABC dışı ek bir cerrahi uygulanacak olan ve acil operasyona alınan hastalar çalışmaya alınmadı. Olguların preoperatif dönemde kullanmakta oldukları statin, beta-bloker ve anjiyotensin dönüştürücü enzim inhibitörü / anjiyotensin reseptör blokeri (ACEİ/ARB) gibi ilaçlar postoperatif dönemde de hastanın durumuna uygun şekilde devam edildi. Sinüs ritminde cerrahiye alınan bir olguda hastanede yatış döneminde saptanan, süreden bağ...

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Section: Discussionunclassified

Value of interatrial conduction time and P wave dispersion in prediction of atrial fibrillation following coronary bypass surgery

Ceylan¹,

Bayata²,

Yeşìl³

et al. 2010

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

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“…In comparing these two strategies in patients with prolonged P-wave duration (> 120 msec) at baseline, multisite pacing resulted in less paroxysmal (30% vs 68%) and permanent AF (3% vs 38%). There was no benefit with multisite atrial pacing when compared with the single-site group with P-wave duration less than 120 msec [45]. In a small study of 19 patients, no benefit was found with biatrial pacing compared with RA pacing [46].…”

Section: Multiple Site Atrial Pacing: Chronic Implantationmentioning

confidence: 97%

“…Of note, there was adjustment of antiarrhythmic medications during the study period. Leclercq et al [45] compared the efficacy of multisite atrial pacing (high right atrium and coronary sinus) in 30 patients with single-site atrial pacing in 53 patients. In comparing these two strategies in patients with prolonged P-wave duration (> 120 msec) at baseline, multisite pacing resulted in less paroxysmal (30% vs 68%) and permanent AF (3% vs 38%).…”

Section: Multiple Site Atrial Pacing: Chronic Implantationmentioning

confidence: 99%

Device-based therapies for atrial fibrillation

Bruce¹,

Friedman

2005

Curr Treat Options Cardio Med

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Ablation of the atrioventricular conduction system and pacemaker implantation is the preferred procedure for patients with atrial fibrillation (AF) in whom a rate control strategy has been selected but in whom rate-controlling medications are intolerable or ineffective. Selection of standard right ventricular (RV) pacing versus biventricular pacing is individualized, based on the degree and etiology of left ventricular dysfunction. Atrial-based pacing is clearly preferable to ventricular-based pacing in patients with sick sinus syndrome, because it leads to a reduction in the development of AF. Emerging evidence indicates that excess RV pacing is deleterious, increasing AF, heart failure, and possibly mortality. Therefore, physiologic pacing with minimization of RV pacing is desirable. Atrial pacing algorithms that increase the frequency of atrial pacing have shown modest efficacy in the prevention of AF. Use of atrial pacing algorithms is reasonable for patients with a history of AF and standard bradycardia indications for permanent pacing in whom maintenance of sinus rhythm is desirable. Studies assessing novel and multiple site atrial pacing therapies have mixed results, without compelling evidence of clinically important benefit. The exceptions are biatrial and right atrial overdrive pacing immediately after cardiac surgery. Several studies have shown effective suppression of postoperative AF with their use. Device therapy (eg, atrial antitachycardia pacing and defibrillation) for the termination of AF is effective in reducing arrhythmia burden. However, improvement in clinically relevant end points is not established and indications are not clearly defined. If a patient lacks an indication for an implantable cardioverter-defibrillator, we do not offer atrial defibrillation as a treatment option. Atrial arrhythmias may be better prevented by programming to avoid ventricular pacing than by specific atrial interventions.

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“…Special points The SYNBIAPACE (Biatrial Synchronous Pacing for Atrial Arrhythmia Prevention) study showed no difference in time until the first recurrence of AF with biatrial synchronization compared with single-site right atrial pacing. Dual-site pacing shows more promise [24]. The DAPPAF (Dual Site Atrial Pacing to Prevent Atrial experienced centers.…”

Section: Rhythm Control Pacingmentioning

confidence: 99%

Atrial fibrillation

Bagai

Avitall

2001

Curr Treat Options Cardio Med

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The conversion of atrial fibrillation (AF) to normal sinus rhythm should be attempted in patients who present with this condition, as long as the cure is not worse than the disease itself. In young patients with normal hearts, AF has a small impact on morbidity and mortality. The primary indication for conversion in this population is often symptoms. In contrast, in patients with diseased hearts or who are older than 65 years, maintaining sinus rhythm may have a favorable impact on stroke risk, ventricular function, and symptoms. In the absence of normal sinus rhythm, these patients should receive anticoagulants. Rate control is the preferred first-line strategy for asymptomatic patients and patients presenting with a history of long-standing, persistent AF, making conversion and maintenance of sinus rhythm unlikely. Rate control may be used in patients who develop AF during an acute systemic illness, which will likely terminate with time or therapy. Conversion to sinus rhythm should be considered in patients with a first episode of AF, as unconverted AF tends to perpetuate itself. Conversion can be attempted if the duration of AF is less than 48 hours or if the patient has received anticoagulants when the duration is not known. Other indications for cardioversion are prolonged episodes in patients with otherwise infrequent episodes of paroxysmal AF, and in patients who refuse to take anticoagulants or in whom anticoagulation is contraindicated. After the patient is converted to sinus rhythm, the decision to initiate chronic drug therapy should be based on the presence of other cardiac and medical diseases that increase the risk of recurrence and serious symptoms in case of recurrence (such as hypertrophic cardiomyopathy or mitral stenosis). It is acceptable to manage patients with new-onset AF and normal cardiac function with cardioversion alone and not initiate chronic antiarrhythmic therapy afterwards. However, in patients with abnormal hearts (coronary artery disease, hypertensive or mitral valvular heart disease, and cardiomyopathy) AF is likely to recur, and such patients should be placed on antiarrhythmic medication.

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Is Dual Site Better Than Single Site Atrial Pacing in the Prevention of Atrial Fibrillation?

Cited by 51 publications

References 25 publications

Value of interatrial conduction time and P wave dispersion in prediction of atrial fibrillation following coronary bypass surgery

Value of interatrial conduction time and P wave dispersion in prediction of atrial fibrillation following coronary bypass surgery

Device-based therapies for atrial fibrillation

Atrial fibrillation

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