Atrial septal pacing to prevent atrial fibrillation in patients with sinus node dysfunction: results of a randomized controlled study.
BACKGROUND
In order to assess the preventive effects of right atrial septal pacing on atrial fibrillation (AF) in patients with sinus node dysfunction, we conducted a prospective randomized controlled study in patients requiring atrial pacing.


METHODS
The inclusion criterion was the presence of a sinus node dysfunction with or without episodes of AF. Pacing sites were randomized to either the right atrial septum or appendage. Patients with permanent AF or with atrioventricular (AV) block without sinus node dysfunction were excluded. Patients were discharged at a pacing rate of 65 beats per minute after setting of the optimal AV delay. The antiarrhythmic therapy remained unchanged until the first recurrence of AF. Sequential analyses were performed with the triangular test.


RESULTS
Mean baseline characteristics were not different between the septum (n = 57) and the appendage (n = 67) groups. The triangular test evidenced a lack of effect of septal pacing at the last sequential analysis. The rates of AF-free survival were not different between the septum and the appendage group (65% vs 64%, P =.28). In the subgroup of patients with at least 1 episode of AF 3 months before pacing, AF-free survival was increased by atrial septal pacing (70% vs 40%, P =.018). The mean follow-up was 16 +/- 13 months (range, 1-54).


CONCLUSIONS
Atrial septal pacing does not have a preventive effect on the occurrence of AF in patient requiring atrial pacing for sinus node dysfunction. Subgroup analysis suggests that atrial septal pacing may benefit patients with >or=1 episode of AF in the 3 months preceding pacing.
Cardiology Department, University Hospital, Amiens, France. hermida.jean-sylvain@chu-amiens.fr
Jean-Sylvain
JS
Hermida
MacIej
M
Kubala
François-Xavier
FX
Lescure
Jean
J
Delonca
Jérome
J
Clerc
Akli
A
Otmani
Geneviève
G
Jarry
Jean-Luc
JL
Rey
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006325:Heart Atria; D006346:Heart Septum; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055502:Secondary Prevention; D012849:Sinoatrial Node