title: Interatrial septum pacing guided by three-dimensional intracardiac echocardiography.
abstract: 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.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. szili@card.azr.nl
authors.forename: Tamas
authors.initials: T
authors.lastname: Szili-Torok
authors.forename: Geert Jan P
authors.initials: GJ
authors.lastname: Kimman
authors.forename: Marcoen F
authors.initials: MF
authors.lastname: Scholten
authors.forename: Jurgen
authors.initials: J
authors.lastname: Ligthart
authors.forename: Nico
authors.initials: N
authors.lastname: Bruining
authors.forename: Dominic A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Klootwijk
authors.forename: Jos R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Jordaens
mesh_terms: 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