title: Prolongation of atrial effective refractory period with biatrial nonexcitatory stimulation.
abstract: BACKGROUND
  A nonexcitatory, nonpropagating atrial extrastimulus delivered in the refractory period of the preceding cycle can prolong the atrial effective refractory period (AERP) and prevent the induction of atrial fibrillation by another AE introduced in the vulnerable period. Whether the effect of this nonexcitatory stimulation (NE) is confined only to its application site is unknown.
  
  
  RESULTS
  Sixteen consecutive patients were recruited into the study and 2 patients were excluded because of development of more sustained atrial fibrillation. NE was commenced by introduction of a 2.0 msec, 20-mA impulse at 50 msec after the preceding captured pacing impulse. AERP of right atrial septum, a distant site to NE application, was determined at baseline and after 5 minutes of steady pacing at six different protocols: protocol 1, 2, and 3 were conventional pacing at high right atrium, distal coronary sinus, and biatrial sites, respectively, and protocol 4, 5, and 6 were conventional pacing together with NE applied to the same sites as protocol 1, 2, and 3. Biatrial NE (protocol 6 with median AERP = 212.5 msec) significantly prolonged AERP compared with baseline (median AERP = 202.5 msec and P < 0.05), conventional pacing (protocol 1, 2, and 3 with median AERP = 205.0 msec, 205.0 msec, and 205.0 msec, respectively, and all P < 0.05), and single-site NE (protocol 4 and 5 with median AERP = 207.5 msec and 207.5 msec, respectively, and both P < 0.05).
  
  
  CONCLUSIONS
  Biatrial NE resulted in AERP prolongation even at sites distant to NE application. The study result suggests that by adding NE to multi-sites pacing for atrial fibrillation prevention may have additional benefit.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China. jyschan@cuhk.edu.hk
authors.forename: Joseph Y S
authors.initials: JY
authors.lastname: Chan
authors.forename: Jeffery W H
authors.initials: JW
authors.lastname: Fung
authors.forename: Hamish C K
authors.initials: HC
authors.lastname: Chan
authors.forename: Winnie W L
authors.initials: WW
authors.lastname: Chan
authors.forename: Cheuk Man
authors.initials: CM
authors.lastname: Yu
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial; D004558:Electric Stimulation; D004562:Electrocardiography; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D012032:Refractory Period, Electrophysiological