Interatrial septum pacing guided by three-dimensional intracardiac echocardiography.
OBJECTIVE
Currently, the interatrial septum (IAS) pacing site is indirectly selected by fluoroscopy and P-wave analysis. The aim of the present study was to develop a novel approach for IAS pacing using intracardiac echocardiography (ICE).


BACKGROUND
Interatrial septum pacing may be beneficial for the prevention of paroxysmal atrial fibrillation.


METHODS
Cross-sectional images are acquired during a pull-back of the ICE transducer from the superior vena cava into the inferior vena cava by an electrocardiogram- and respiration-gated technique. Both atria are then reconstructed using three-dimensional (3D) imaging. Using an "en face" view of the IAS, the desired pacing site is selected. Following lead placement and electrical testing, another 3D reconstruction is performed to verify the final lead position.


RESULTS
Twelve patients were included in this study. The IAS pacing was achieved in all patients including six suprafossal (SF) and six infrafossal (IF) lead locations all confirmed by 3D imaging. The mean duration times of atrial lead implantation and fluoroscopy were 70 +/- 48.9 min and 23.7 +/- 20.6 min, respectively. The IAS pacing resulted in a significant reduction of the P-wave duration as compared to sinus rhythm (98.9 +/- 19.3 ms vs. 141.3 +/- 8.6 ms; p < 0.002). The SF pacing showed a greater reduction of the P-wave duration than IF pacing (59.4 +/- 6.6 ms vs. 30.2 +/- 13.6 ms; p < 0.004).


CONCLUSIONS
Three-dimensional ICE is a feasible tool for guiding IAS pacing.
Szili-Torok
Tamas
T
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. szili@card.azr.nl
Kimman
Geert Jan P
GJ
Scholten
Marcoen F
MF
Ligthart
Jurgen
J
Bruining
Nico
N
Theuns
Dominic A M J
DA
Klootwijk
Peter J
PJ
Roelandt
Jos R T C
JR
Jordaens
Luc J
LJ
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D005240:Feasibility Studies; D005260:Female; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged