title: Dual-site right atrial pacing increases left atrial appendage flow in patients with sick sinus syndrome and paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Dual-site right atrial pacing has been proposed as a promising concept for prevention of paroxysmal atrial fibrillation (PAF). Effects of this pacing configuration on left atrial appendage (LAA) flow and transmitral flow may be of prognostic and hemodynamic relevance. This study aims to characterize acute changes in left atrial flow depending on dual-site right atrial pacing.
  
  
  METHODS
  In 12 patients (66 +/- 8.8 years, 4 women) with PAF and sinus bradycardia a pacemaker with a right atrial dual-site lead configuration (right atrial lateral and coronary sinus ostium) was implanted. Flow velocities in the left pulmonary vein (LPV), LAA, and across the mitral valve were assessed by transesophageal echocardiography and compared during sinus rhythm (SR) and dual-site (DS) pacing.
  
  
  RESULTS
  Dual-site pacing resulted in higher maximum (SR: 0.57 m/s; pacing: 0.77 m/s; P < 0.02) and mean (SR: 0.33 m/s; DS: 0.47 m/s; P < 0.01) LAA emptying flow when compared with SR. The passive transmitral flow component (maximum E-wave velocity) was lower during dual-site pacing (SR: 0.53 m/s vs DS: 0.44 m/s, P < 0.02). The E/A ratio tended to be lower during dual-site pacing (SR: 1.21 vs DS: 1.01, P = 0,10). LPV flow velocities during SR and DS pacing did not differ.
  
  
  CONCLUSIONS
  DS right atrial stimulation in patients with PAF increases the LAA emptying flow velocity and shifts the transmitral flow pattern towards a lower passive component when compared with sinus rhythm. The change in LAA flow may contribute to a lower incidence of thromboembolism and merits further investigation.
authors.affiliation: Department of Cardiology, Charité--Universitaetsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany. martin.stockburger@charite.de
authors.forename: Martin
authors.initials: M
authors.lastname: Stockburger
authors.forename: Ralf
authors.initials: R
authors.lastname: Bartels
authors.forename: Lars
authors.initials: L
authors.lastname: Gerhardt
authors.forename: Christian
authors.initials: C
authors.lastname: Butter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D001783:Blood Flow Velocity; D002304:Cardiac Pacing, Artificial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012039:Regional Blood Flow; D012804:Sick Sinus Syndrome / Q000503:physiopathology* / Q000628:therapy*