Septal atrial pacing for the prevention of atrial fibrillation.
OBJECTIVE
Atrial fibrillation (AF) produces significant morbidity and mortality. The current method of permanent pacing of the right atrium (RA) may cause delayed interatrial conduction and predispose to AF. We hypothesized that atrial septal pacing would reduce AF compared with high RA pacing.


RESULTS
The patients were randomized into two groups. After randomization, patients received a dual-chamber rate-responsive device capable of mode-switching with advanced telemetry features. Devices were programmed in a standardized manner. To be eligible, the patients were required to have a conventional indication for a permanent pacemaker and recurrent paroxysmal AF. Group 1 was paced from high RA and Group 2 was paced from the atrial septum. Analysis of 43 patients who have completed 6 months of follow-up and 22 patients who completed 12 months of follow-up showed no significant differences in the number of mode-switching episodes or in AF burden between groups (P = NS by Mann-Whitney) although there was a trend for less AF with septal pacing. There were no differences in thresholds, sensing, or lead impedance. Lead parameters remained stable over time and there were no displacements of the electrodes after implantation. No patient experienced lead-related complications. A significant variability in AF burden was noted in this patient population.


CONCLUSIONS
Implantation of an atrial-active fixation lead on the atrial septum is safe and feasible. However, this study showed no significant difference between septal pacing and high atrial pacing, using the endpoints of AF duration and number of AF episodes.
Hakacova
Nina
N
Children's Cardiac Centre, Bratislava, Slovak Republic.
Velimirovic
Dusan
D
Margitfalvi
Peter
P
Hatala
Robert
R
Buckingham
Thomas A
TA
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D054087:Atrial Septum / Q000294:innervation / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D006325:Heart Atria / Q000294:innervation / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D016896:Treatment Outcome