title: Prevention of short term reversible chronic atrial fibrillation by permanent pacing at the triangle of Koch.
abstract: OBJECTIVE
  The purpose of this study was to investigate if single lead interatrial septum pacing could be effective in maintaining sinus rhythm in patients in whom restoration of sinus rhythm was only possible for a period of 2-24 hours after one or more previous electrical cardioversions, and in whom a sinus bradycardia was documented before arrhythmia restarted. The two hours limit was chosen because it was considered a sufficient time to implant a dual chamber pacemaker.
  
  
  BACKGROUND
  Alternative atrial pacing techniques have been demonstrated to be successful in preventing recurrences of atrial fibrillation (AF) in patients with sinus bradycardia. Excluding the AF occurring after only a few sinus beats, at 24 hours from electrical cardioversion an early restart of chronic AF has been reported in 12% to 17% of the patients.
  
  
  METHODS
  After sinus rhythm was restored by internal electrical cardioversion, 17 patients, 7 ablated at the AV junction, underwent a dual chamber rate response (DDDR) pacemaker implantation with a screw-in atrial lead placed in the interatrial septum.
  
  
  RESULTS
  After a follow-up period of 17+/-5 months (range 12 to 27 months) persistence of sinus rhythm was observed in 11 patients (65%). Six patients (35%) had recurrences of paroxysmal attacks, while five (30%) were totally free of AF. Recurrence of chronic AF was observed in six cases (35%) after 2 days-12 months from implantation. No dislodgements of the atrial lead and no complications were observed at implantation and during follow-up.
  
  
  CONCLUSIONS
  Interatrial septum pacing is a safe and feasible technique with a satisfying success rate (65%) in long-term maintaining sinus rhythm in previously unsuccessfully cardioverted patients.
authors.affiliation: Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy. c.porciani@dfc.unifi.it
authors.forename: L
authors.initials: L
authors.lastname: Padeletti
authors.forename: M C
authors.initials: MC
authors.lastname: Porciani
authors.forename: A
authors.initials: A
authors.lastname: Michelucci
authors.forename: A
authors.initials: A
authors.lastname: Colella
authors.forename: A
authors.initials: A
authors.lastname: Costoli
authors.forename: C
authors.initials: C
authors.lastname: Ciapetti
authors.forename: P
authors.initials: P
authors.lastname: Pieragnoli
authors.forename: N
authors.initials: N
authors.lastname: Musilli
authors.forename: G F
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000517:prevention & control*; D002036:Bundle of His / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016896:Treatment Outcome